A053 Early Single-Centre Experience of a Nurse-led Sacubitril/Valsartan Initiation and Titration Clinic: A Retrospective Analysis

Abstract

Background: Sacubitril/valsartan has changed the landscape of the pharmacological therapy of heart failure with reduced ejection fraction (HFrEF). We present our single-centre nurse-led initiation and titration clinic findings from Waikato Hospital. Method: Our retrospective analysis includes 149 consecutive patients with HFrEF who were commenced on sacubitril/valsartan by the Heart Failure Clinical Nurse Specialist (HF CNS) clinic between 1 October 2018 and 30 September 2019. Statistical analyses for Wilcoxon signed-rank test (two-tailed) were performed using Prism 8. Results: Our cohort of 149 patients were predominantly male (81%) with a median age of 68. The majority were either European (72%) or Māori (25%). Two-thirds (64%) were aetiologically non-ischaemic. Mean systolic blood pressure, mean GFR, mean weight and mean serum K+ were similar at baseline and at 6 month follow-up. 69% achieved target dose and 6% had withdrawal of sacubitril/valsartan. 36% had reduction in loop diuretic dose and 18% had mineralocorticoid antagonist withdrawn. Statistically significant differences were observed with decrease in NYHA Class (z = -7.961; p <.00001), decrease in NT-pro BNP (z = -6.441; p <.00001) and improvement in LVEF (z = -6.052; p <.00001) across the cohort. 10% (n = 15) were hospitalised for HF and 3.4% died (n = 5) within 6 months of commencing sacubitril/valsartan. Conclusion: Our early, single-centre experience with a nurse-initiated and led sacubitril-valsartan clinic has yielded results in keeping with the data from the PARADIGM-HF trial, whereby patients experience an improvement clinically (NYHA Class), biochemically (NT-pro BNP) and echocardiographically () with a favourable adverse effect profile. Further insights will be gleaned with longer-term follow-up in our cohort. [Formula presented]