THE BRITISH COLUMBIA SACUBITRIL-VALSARTAN REGISTRY: RATIONALE AND BASELINE DEMOGRAPHICS

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Sacubitril-valsartan is approved in Canada for treatment of heart failure (HF) with reduced ejection fraction based on results from the landmark PARADIGM-HF Trial. There is a paucity of real world data describing the impact of this novel therapy on healthcare utilization (HCU) including healthcare provider visits, the need for additional diagnostic imaging/laboratory testing as well as potential avoidance of CRT/ICD. To measure the system impact of sacubitril-valsartan on HF care in BC, Cardiac Services BC and BC’s Heart Failure Network have created a Provincial registry to identify and track outcomes for patients initiated on this therapy. This is a multicentre Provincial cohort of 178 patients initiated on sacubitril-valsartan between March 2016-April 2017. Baseline demographic data was captured at the time of drug initiation. We present here a descriptive analysis of our initial study cohort based on NYHA functional class, left ventricular ejection fraction (LVEF), baseline renal function and treatment with guideline-directed medical therapy (GDMT). The majority of patients in the BC Registry initiated on sacubitril-valsartan had either NYHA II (74.7%) or NYHA III (11.2%) functional symptoms. A baseline LVEF < 40% was present in 94% of patients. Echocardiography was the primary diagnostic imaging modality for baseline assessment of LVEF. The mean eGFR was 64.3±18.3 mL/min (n=165) with a median eGFR of 63 mL/min (IQR 49,77). Only one patient had an eGFR < 30 ml/min. Prior to initiation of sacubitril-valsartan, GDMT for HFrEF including beta-blocker, ACEi/ARB and MRA was employed in 70.2% of those enrolled in the registry, however only 24.7% (n=44) of those on triple-therapy were receiving optimal guideline recommended doses. Target doses of beta-blockers, ACEi/ARB and MRA were achieved in 67.4% (n=120), 70% (n=125) and 38.2% (n=68) respectively of registry participants. Early data from the BC sacubitril-valsartan registry suggests that this therapy is being used in appropriate patients with respect to symptoms, LVEF and renal function. There is a significant care gap related to optimal dosing of GDMT with under-treatment across all drug classes prior to initiation of sacubitril-valsartan. Barriers to up-titration of GDMT must be explored. As a next step in quality assurance, we will link registry data with Provincial administrative data sets to determine the real world impact of sacubitril-valsartan on HCU in the BC context.