A006 Sacubitril/Valsartan (Entresto) in a Multi-Ethnic Population

Abstract

Implementation of clinical trial evidence into clinical practice can be challenging especially for “real world” patients with heart failure (HF) who commonly exhibit higher risk characteristics associated with more severe disease than those included in clinical trials. The Heart Function Team (HFT) at Auckland City Hospital report there experience with implementation of Sacubitril/Valsartan. Patients with HFrEF were seen by the HFT and data on the process and impact on the clinical service was collated. 50 patients were transitioned to sacubitril/valsartan, mean age 58yrs (range 27-83yrs), and 58% non-NZ European. All patients fulfilled the PHARMAC special authority criteria, including LVEF <35% and were receiving optimal disease-modifying HF medications (DMM) ACEI/ARB (100%), Beta-Blocker (90%), MRA (72%). Patients initiated on low-dose of sacubitril/valsartan had lower baseline BP and lower dosages of DMM than those initiated on mid-range dose. Of those starting on low-dose sacubitril/valsartan 75% were able to tolerate mid-range or target dose, while those started on mid-range 87% were able to tolerate target dose. The average decrease in SBP was 12 mmHg, hypotension was the most common reason for extra clinic visits. Sacubitril/Valsartan can be incorporated into routine clinical practice for patients with severe HF in NZ. The reduction in blood pressure was more than double that in the clinical trial, consistent with the issues of translation of clinical trial results into the real work of heart failure management. The HFT is well positioned for rapid translation of newer therapies to improve clinical outcomes for patients with HFrEF.