The Use of Sacubitril/Valsartan in an Advanced Heart Failure Clinic is Associated with Decreased Heart Failure Hospitalizations, Improved Left Ventricular Ejection Fraction and Functional Class

Introduction Sacubitril/valsartan has demonstrated improvement in survival in patients with heart failure (HF) and reduced ejection fraction. However, the population studied in the PARADIGM trial may not reflect the patients managed with optimal medical therapy at an advanced heart failure clinic in North America. Our objective was to evaluate the clinical characteristics and outcomes of patients who were initiated on sacubitril/valsartan and followed by Spectrum Health advanced HF clinic. Methods This retrospective study included 177 patients who were initiated on sacubitril/valsartan at the Spectrum Health advanced HF clinic. Epidemiological, pharmacological, clinical, and echocardiographic information was collected. Ejection fraction (EF), functional class, and hospitalizations were compared prior and 6 months after initiation of sacubitril/valsartan. Statistical significance was considered if p Results Our patients were predominantly male (74.1%) and young (57.4±13.7 years) with a median duration of HF of 21 months. Non-ischemic cardiomyopathy was present in 58% of patients. At the time of initiation of sacubitril/valsartan, 82.7% were receiving ACEi or ARB, 98.1% beta-blocker, 55.8% aldosterone antagonist, 11.5% hydralazine or isosorbide, and 69% had an ICD or CRT device. Follow up after the initiation of sacubitril/valsartan was 17±10 months. Of this cohort 48 patients (27%) discontinued sacubitril/valsartan mainly due to side effects. During the follow-up period, 3 patients (1.7%) were listed and 1 patient (0.6%) received a heart transplant, 10 patients (5.6%) received a LVAD, 1 patient (0.6%) selected for VAD, and 10 patients (5.6%) died. Of the 177 patients, 162 patients received sacubitril/valsartan for at least 6 months and among these patients the frequency of HF hospitalizations decreased after sacubitril/valsartan from 41 to 18 (p Conclusion At our advanced HF clinic, patients who received sacubitril/valsartan for at least 6 months had an improvement in functional capacity, left ventricular ejection fraction and decreased rate of hospitalizations. One in every four patients discontinued sacubitril/valsartan and 14.1% of patients reached the combined outcome of death/LVAD/heart transplant/list transplant/VAD selected, underlining the importance of close follow up in this population.