EARLY USE OF SACUBITRIL/VALSARTAN FOLLOWING ACUTE DECOMPENSATED HEART FAILURE WITH REDUCED EJECTION FRACTION: FEASIBILITY AND UNVEILING FACTORS

Abstract

Abstract Introduction Sacubitril/Valsartan plays a pivotal role in treating heart failure with reduced ejection fraction (HFrEF), reducing cardiovascular mortality and hospitalizations. Despite its effectiveness, real-world data indicate persistent underprescription due to management complexity, modest tolerability, therapeutic inertia and regulatory constraints. The TRANSITION study in acute decompensated heart failure (ADHF) demonstrated the feasibility of initiating Sacubitril/Valsartan in hospitalized patients with HFrEF. Our study aims to establish the safety and tolerability of early Sacubitril/Valsartan prescription during ADHF hospitalization and investigate reasons of its underprescription. We present preliminary data from 20 consecutive ADHF patients admitted to our department between August and October 2023. Methods We collected data from patients with HFrEF diagnosis according to current guidelines. Patient data were documented during hospitalizations, and therapeutic regimens at admission were compared with those at discharge. We also reported systolic arterial pressure, creatinine levels, glomerular filtration rate and kaliemia values. Results Patients had a mean age of 75±12.8, and 80% were men. The mean ejection fraction was 30.7% ± 5.6. BMI was 26.9±4.3, and 40% of the patients had diabetes. The mean hospital stay was 5.4 ± 4.1 days. The utilization of Sacubitril/Valsartan at admission was 25% up to 75% at discharge (p = 0.001). Concurrently, beta-blocker usage increased from 55% to 90% (p = 0.013), SGLT2 inhibitors from 55% to 75% (p = 0.001), and MRAs from 30% to 80% (p = 0.001). Systolic arterial pressure decreased not significantly (p = 0.189) as well as the glomerular filtration rate (p = 0.51). Kaliemia remained stable from 4.09±0.45 mEq/l to 4.14±0.45 mEq/l (p = 0.72). The prescribed dosage of Sacubitril/Valsartan was 50 mg bid in 80% of patients, 100 mg bid in 13,3% and 200 mg in 6,6%. Among patients who didn’t receive Sacubitril/Valsartan, four patients had an absolute contraindication represented by a GFR < 30 ml/min and one patient didn’t receive the drug due to an episode of cardiogenic shock. Discussion Our analysis highlights the underutilization of ARNi in HFrEF and the feasibility of early Sacubitril/Valsartan use in ADHF. The optimization of the therapy during hospitalization had no significant impact on key parameters. Advanced renal dysfunction represents the major limitation of Sacubitril/Valsartan prescription.