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Assessing suitability for sacubitril-valsartan therapy in an Irish cohort: challenges and opportunities

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Abstract

Introduction

Sacubitril-valsartan has been shown by the PARADIGM-HF trial to decrease hospital admissions and improve mortality in patients with heart failure with reduced ejection fraction. The PARADIGM trial had stringent exclusion criteria. It is not known how applicable these trial criteria are to real-life practice. In this study, we sought to determine the percentage of patients eligible for sacubitril-valsartan therapy in a level 3 hospital without a dedicated heart failure service.

Methods

All patients discharged from our service with a diagnosis of congestive cardiac using our hospital in-patient enquiry (HIPE) system underwent hierarchal analysis. In order to be deemed eligible for sacubitril-valsartan therapy, patients had to meet PARADIGM-HF inclusion criteria.

Results

Our 143 patients represented a more clinically unwell, elderly cohort than the PARADIGM trial study population. Only 24 patients (16.66%) had an ejection fraction of 40% or less. Our results indicate that only 4/143 patients in a real-world setting (2.79%) were eligible for sacubitril-valsartan therapy at the point of discharge as per the PARADIGM-HF study criteria. This is primarily due to the higher than expected percentage of patients in our cohort with an ejection fraction of over 40% (n = 120) and the low percentage of patients on therapeutic doses of ACEI/ARB (n = 15).

Conclusions

Our study showed that a smaller than expected proportion of our patients in real-world practice are suitable for sacubitril-valsartan therapy at discharge. Most patients were in the HFPEF cohort which does not currently have evidence for treatment with sacubitril-valsartan. Low rates of prescribing of basic heart failure medicatons and the absence of dedicated heart failure services in a non-tertiary centre may explain the poor compliance observed. Improving guideline adherence and increasing awareness of evidence-based medication use at primary and secondary care levels would be of benefit to Irish heart failure patients.

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Authors and Affiliations

  1. University Hospital Kerry, Tralee, Co. Kerry, Ireland

    Aidan Daly, John J. Coughlan, Thomas Mross, Megan Wafer, Aoife O’Connor & Richard Liston

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  1. Aidan Daly
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  2. John J. Coughlan
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  3. Thomas Mross
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  4. Megan Wafer
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  5. Aoife O’Connor
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  6. Richard Liston
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Correspondence to Aidan Daly.

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The authors declare that they have no conflict of interest.

Ethical statement

This retrospective study was discussed with and approved by the Ethics Committee at University Hospital Kerry. As this was a retrospective analysis, informed consent was not required.

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Daly, A., Coughlan, J.J., Mross, T. et al. Assessing suitability for sacubitril-valsartan therapy in an Irish cohort: challenges and opportunities. Ir J Med Sci 188, 1169–1174 (2019). https://doi.org/10.1007/s11845-019-01990-0

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