Real-Word Evidence of Improvement in Quality-of-Life Score, New York Heart Association Class and Tolerability of Valsartan/Sacubitril in Patients with Heart Failure

Abstract

The PARADIGM-HF study demonstrated that valsartan/sacubitril (Entresto) decreases heart failure (HF) hospitalisation, cardiovascular mortality, and all-cause mortality in patients with HF with reduced ejection fraction [ [1] McMurray J.J.V. Packer M. Desai A.S. Gong J. Lefkowitz M.P. Rizkala A.R. et al. Angiotensin–neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014; 371: 993-1004 Crossref PubMed Scopus (3943) Google Scholar ]. Since the addition of Entresto to the Pharmaceutical Benefit Scheme in June 2017, there has been considerable uptake of this drug. The aim of this study was to assess efficacy, tolerability, and complications of Entresto with real-word evidence. We identified patients who were commenced on Entresto from 1 June 2017 to 30 November 2017 at a tertiary centre in Victoria via pharmacy dispensing database. In total, 33 patients were commenced on Entresto with median age of 65 years, median EF was 31% with 57% secondary to ischaemic cardiomyopathy. Twenty-seven of 33 patients were followed up via telephone/clinic/patient records with three deaths in the time period. There was strong correlation in improvement in quality-of-life scores (EQ-5D), pre versus post: 50 vs 65 (p < 0.05), New York Heart Association (NYHA) class (p < 0.05), and average blood pressure reduction from 119 (range 101–137) to 110 (range 95–125) mmHg since the commencement of Entresto. Starting dose of Entresto was 24/26 mg in 60% of patients and was uptitrated in 37%. Only 14% were able to able to achieve recommenced maximal dose (97/103 mg). The most common side effect was symptomatic hypotension, which led to dose reductions or complete cessation. Our study provides evidence that Entresto results in symptom improvement in addition to blood pressure reduction in patients with heart failure with reduced ejection fraction, as well as common side effects of this drug. Further research is required to demonstrate whether these outcomes are sustained in the longer term.