In HFREF patients, sacubitril/valsartan, given at relatively low doses, does not lead to increased mortality or hospitalization

• Published in: Herz Vol. 44; no. 7; pp. 651 - 658
• Main Authors: De Vecchis, R, Ariano, C, G Di Biase, Noutsias, M
• Format: Journal Article
• Language: English
• Published: Munich Springer Nature B.V 01.11.2019
• Subjects: Confidence intervals; Heart diseases; Heart failure; Hospitalization; Mortality; Patients; Ventricle
• ISSN: 0340-9937; 1615-6692
• DOI: 10.1007/s00059-018-4690-6

IntroductionIn heart failure with reduced left ventricular ejection fraction (HFREF) patients, the dosage of sacubitril/valsartan is modulated according to a gradual increase regimen. Nevertheless, if patients exhibit tolerability problems, a provisional reduction of the dose of sacubitril/valsartan or even its interruption are recommended.Material and methodsThis study provides estimates of respective proportions of patients receiving minimum or intermediate doses of sacubitril/valsartan. In addition, a comparison was made to detect possible differences regarding all-cause mortality and heart failure hospitalization in patients treated with the recommended optimum dose compared to those receiving submaximum maintenance doses of sacubitril/valsartan.ResultsPatients treated with sacubitril/valsartan in addition to beta-blocker and mineralocorticoid receptor blocker were 68. Among them, 20 patients (29.4%), were identified as having clinical features that were contraindications to the administration of sacubitril/valsartan at full dose. The subsequent decision was to maintain an intermediate dose in 11 patients and to reduce the dose to the minimum level allowed, i.e., 24 mg/26 mg twice daily in nine patients. After a median follow-up of 5.25 months, no differences were found concerning the risk of all-cause death by comparing patients treated with reduced versus those subjected to target doses of sacubitril/valsartan (odds ratio [OR] = 1.666; 95% confidence interval [CI] = 0.256–10.823; p = 0.6266). Patients taking reduced doses had a similar risk of heart failure hospitalizations when compared to patients treated with the target dose (OR = 0.789; 95% CI: 0.077–8.0808; p = 1.00).ConclusionDuring a median follow-up of 5.25 months, in the group of patients who had proven to be intolerant to the maximum dose of sacubitril/valsartan, use of reduced doses of the drug did not result in increased all-cause mortality or heart failure hospitalization compared to patients treated with sacubitril/valsartan at the target dose.