"Real world" eligibility for sacubitril/valsartan in unselected heart failure patients: data from the Swedish Heart Failure Registry (original) (raw)

Simpson, Joanne, Benson, L., Jhund, P.S. ORCID: https://orcid.org/0000-0003-4306-5317, Dahlström, U., McMurray, J.J.V. ORCID: https://orcid.org/0000-0002-6317-3975 and Lund, L.H.(2019) "Real world" eligibility for sacubitril/valsartan in unselected heart failure patients: data from the Swedish Heart Failure Registry.Cardiovascular Drugs and Therapy, 33(3), pp. 315-322. (doi: 10.1007/s10557-019-06873-1) (PMID:30903545) (PMCID:PMC6538576)

Abstract

Purpose: PARADIGM-HF demonstrated the superiority of sacubitril/valsartan over enalapril in patients with heart failure and reduced ejection fraction (HF-REF). How widely applicable sacubitril/valsartan treatment is in unselected patients with HF-REF is not known. We examined eligibility of patients with HF-REF for treatment with sacubitril/valsartan, according to the criteria used in PARADIGM-HF, in the Swedish Heart Failure Registry (SwedeHF). Methods: Patients were considered potentially eligible if they were not hospitalized, had symptoms (NYHA class II–IV) and a reduced LVEF (≤ 40%), and were prescribed an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) at a dose equivalent to enalapril ≥ 10 mg daily. In these patients, we evaluated further eligibility according to the main additional PARADIGM-HF inclusion criteria. Results: Of 12,866 outpatients in NYHA functional class II–IV with an LVEF ≤ 40%, 9577 were prescribed at least 10 mg of enalapril (or equivalent) daily. Complete additional data were available for 3099 of these patients (32.4%) and of them 75.5% were potentially eligible for treatment with sacubitril/valsartan. The most common reason for ineligibility was a low natriuretic peptide level (n = 462, 14.9%). Only a small proportion of patients were ineligible due to low eGFR or serum potassium level. Because only 78% of patients were taking ≥ 10 mg enalapril or equivalent daily, only 58.9% of all patients (75.5% of 78%) were eligible for sacubitril/valsartan. Conclusions: Between 34 and 76% of symptomatic patients with HF-REF in a ‘real world’ population are eligible for treatment with sacubitril/valsartan, depending on background ACEI/ARB dose. The most common reason for ineligibility is a low natriuretic peptide level.

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