Prescription of LCZ696 in 1442 patients with Heart Failure with reduced Ejection Fraction included in the Multicenter French Survey OFICSEL

Abstract

In paradigm-HF study, LCZ696 was superior to angiotensin converting enzyme inhibitors (ACEI) and reduced mortality in heart failure with reduced ejection fraction (HFrEF) patients. LCZ696 is now recommended in symptomatic patients with HFrEF despite optimal treatment with beta-blockers, ACEI and mineralocorticoid receptor antagonists (MRA). To evaluate LCZ696 prescription in real-life in and outpatients. Prospective enrolment during 6 months in 2017. Data collection included demographic, burden, clinical, biological, echocardiography and treatment characteristics. A total of 1442 patients with left-ventricular ejection fraction (LVEF) < 40% were included of whom 31% were outpatients. Their mean age was 65 ± 14 years and 77% were men. Eighty-three percent were in NYHA II or III class and the mean LVEF was 28.2 ± 6.3%. Ischemic cardiopathy affected 49.8% of the patients. Heart failure was recently diagnosed (< 3 months) in 19% of the patients. A total of 343 patients were treated with LCZ696 (24%), in association with beta-blocker (91%) and, or MRA (67%). One hundred and nine patients were outpatients (37.1%). Seventeen patients (5%) were treated by LCZ696 and ACEI. As compared with ACEI or angiotensin receptor blockers (ARB) or neither of them, patients treated with LCZ696 were younger ( P < 0.0001) and more likely to be men ( P = 0.016). NYHA status was better ( P < 0.0001), NTpro-BNP was lower ( P < 0.0001) and Minnesota physical score was lower ( P = 0.003) in LCZ696 patients. Patients treated by LCZ696 were more likely to be outpatients ( P < 0.001). Almost one in four patients with LVEF < 40% was treated with LCZ696. Symptoms, cardiac biomarkers and quality of life were improved compared to ACEI, ARB or no treatment. LCZ696 treatment was less prescribed in older patients and women although there is no specific contraindication in this population. The association of ACEI and LCZ696 has to be avoided due to an increased risk of angioedema.