OPTIMAL USAGE OF SACUBITRIL/VALSARTAN FOR HEART FAILURE TREATMENT IN CANADA POTENTIALLY REDUCES HOSPITALIZATIONS AND EARLY DISCHARGE RE-ADMISSIONS

Abstract

Despite multiple evidenced-based therapies, heart failure (HF) continues to be characterized by high hospitalization rates. Sacubitril/valsartan, a first-in-class angiotensin receptor neprilysin inhibitor treatment for HF with reduced ejection fraction (HFrEF) provided incremental cardiovascular and overall survival benefit in PARADIGM-HF in HF patients. The objective of this analysis was to quantify the number of potential hospitalizations and 30-day HF re-admissions avoided with optimal usage of sacubitril/valsartan in the treatment of HFrEF patients in Canada. Data from Statistics Canada was used to quantify the population above 18 years of age. A literature search was then conducted to determine the prevalence of HF in Canada, the proportion of these with NYHA class II and III, and finally the proportion of patients with HFrEF. The number needed to treat (NNT) to avoid one hospitalization or one 30-day HF re-admission, standardized to 12 months was derived from the PARADIGM-HF trial. The potential number of hospitalizations prevented as a result of optimal usage of sacubitril/valsartan as per current approved indication in Canada (patients with HFrEF, ejection fraction ≤ 40% and NYHA class II or III symptoms) was estimated along with multiple-way sensitivity analysis using the analysis-of-extremes method. The main outcomes were HF hospitalizations and 30-day HF re-admission. A Canadian HF prevalence of 2.31% was applied to determine the number of HF patients. Of those, 64% were classified as NYHA Class II and III with 56% considered as HFrEF. It was estimated that in Canada, approximately 242,200 patients are affected with HFrEF with NYHA class II and III. Based on a NNT of 80, optimal usage of sacubitril/valsartan therapy was estimated to prevent 3,016 hospitalizations per year (range, 1,930 – 4,331 per year). Based on a NNT of 61, optimal usage of sacubitril/valsartan therapy was estimated to prevent 3,984 30 day HF re-admissions per year (range, 2,546-5,744). Evidence-based treatment for HF is well-established and has resulted in important reductions of hospitalization but there is still a need for new guideline recommended therapies to further improve hospitalization rates for HFrEF patients. The findings from this analysis suggest that a substantial number of hospitalizations and 30 day HF re-admissions in Canada could potentially be avoided by optimal usage of sacubitril/valsartan therapy. This analysis supports the importance of rapidly implementing evidence-based therapy, in this case sacubitril/valsartan, into routine clinical practice to improve clinical outcomes for HFrEF patients in Canada.