Real World Experience with Entresto in Heart Failure Patients from Regional North Queensland

Abstract

Aim: Evaluate the effectiveness of Entresto (Sacubitril/valsartan), a heart failure medication, at the Mackay Base Hospital. Method: Our clinical audit evaluated 28 consecutive heart failure patients with a mean age of 62 years who were already tolerating maximum doses of angiotensin converting enzyme inhibitors and beta-blockers. Specifically, the cohort comprised of patients in all NYHA classes: class I (2), II (15), III (6) and IV (5). Our primary outcomes included: left ventricular ejection fraction (LVEF), B-type natriuretic peptide (BNP), creatinine, estimated glomerular filtration rate, 6-minute walk test (6MWT). Outcomes were compared at baseline and 6-months post Entresto. The secondary outcomes included the evaluation of responses to the Self-assessment of NYHA (SA-NYHA). Results: The mean LVEF increased from 30 ± 9% to 42 ± 10% (p < 0.01) at 6 months. The average BNP decreased from 766 ± 1201 pg/mL to 328 ± 511 pg/mL (p < 0.01). 6MWT distance improved from 288 ± 159 m to 394 ± 188 m (p = 0.004). 32%, 54% and 14% of patients respectively reported an improved, unchanged or a worse NYHA score. 80% of NYHA class 4 patients improved their SA-NYHA score by at least 1 class. Conclusion: Similarly to the PARADIGM-HF study, our results confirm that Entresto is effective in improving the cardiac function and exercise capacity of patients who were previously tolerating maximal heart failure therapy. Unlike the study however, our small cohort included a greater percentage of NYHA class 4 patients (0.8% vs 18%). Thus, we also demonstrated that Entresto can benefit a broader spectrum of heart patients including those classified as NYHA IV.