116 Gusto for Entresto: A Retrospective Audit of Real-Life Tolerability and Effectiveness in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

Abstract

An audit to evaluate the actual application of Entresto® (sacubitril-valsartan) in a physical clinical setting was conducted in a South-East Queensland tertiary hospital. The aim of the study was to investigate the effect of tolerability and effectiveness in heart failure patients with reduced ejection fraction (<40%). Retrospective audits of patients’ records from November 2017-December 2018 were used to identify the barriers in achieving the recommended target Entresto® doses. A data collection tool was designed using Microsoft Excel. Ethics exemption was sought and approved as part of a Quality Use of Medicines project. Of the 76 patients, only 35% of patients reached the maximum dose of 97mg/103mg twice- daily, 33% on 49mg/51mg twice daily and 28% on 24mg/26mg twice daily. The most common reason for not reaching target maximum dose was hypotension (i.e. clinical and symptomatic hypotension). No documented reasons were specified for 18% of patients. Fifty patients (66%) experienced an increase in Left Ventricular Ejection Fraction (LVEF) ranging from 5-45%, while 13 (17%) patients saw no improvement and 13 (17%) showed a decrease. In conclusion, Entresto® demonstrated LVEF increased in more than half of the patients identified, with the majority of the patients (64%) on low to moderate doses (≤49/mg/51mg twice daily). Adverse effect similar to those described in PARADIGM-HF, were a major reason not achieving target doses. The availability of follow-up echocardiogram reports was a limitation of this study.