Left Ventricular Ejection Fraction Improvement Post Commencement of Sacubitril/Valsartan in Heart Failure Patients

Abstract

Sacubitril/Valsartan decreases HF hospitalisation, cardiovascular mortality and all-cause mortality in patients with HF with reduced ejection fraction (HFrEF) [[1]McMurray J.J.V. et al.Angiotensin-neprilysin inhibition versus enalapril in heart failure.The New England Journal of Medicine. 2014; 371: 993-1004Crossref PubMed Scopus (3930) Google Scholar]. Since addition of Sacubitril/Valsartan to Pharmaceutical Benefit Scheme in June 2017, there has been considerable uptake of this drug. The aim of this study was to assess the effect of Sacubitril/Valsartan on left ventricular ejection fraction (LVEF) in clinical practice using an intention to treat analysis in order to provide a real world experience. Data were collected to include patients from 1st January 2017 to 31st December 2017 at a major metropolitan centre in Melbourne, Victoria via the pharmacy dispensing and clinic database. 65 patients were assessed in this study and the majority of patients had NYHA score III with pre-dominant male representation with 49 male and 16 females in the cohort. The mean age of the patients was 65.1 years (SD 12.5 years). 49% patients were diagnosed with ischaemic cardiomyopathy and 51% non ischaemic cardiomyopathy. In a 6–12 month follow-up, there was a significant improvement in LVEF from 29.1 ± 9.7% at baseline to 33.8 ± 9.9% at follow up (p < 0.05). Sacubitril/Valsartan is a much needed therapeutic advancement in treatment of heart failure and supplements the current evidence-based maximal medical therapy. It provides LVEF improvement even in low doses and in a short time interval as evident in our study. However, further research is necessary to demonstrate whether these outcomes are sustained in the longer-term in the HFrEF population.