American Journal of Cardiovascular Drugs

, Volume 18, Issue 2, pp 143–151 | Cite as

Evaluating the Safety and Tolerability of Sacubitril/Valsartan for HFrEF Managed Within a Pharmacist Clinic

short communication



The objective of this research was to describe the use of pharmacist-managed sacubitril/valsartan therapy in a multi-center, outpatient cardiac group.


Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNi), is a novel agent for the treatment of heart failure. An ARNi is recommended by national guidelines to be used in place of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) therapy for patients who remain symptomatic.


A retrospective chart review was performed to identify patients initiated and fully titrated on sacubitril/valsartan therapy from July 7, 2015 to March 7, 2017.


Fifty-two of the 72 symptomatic heart failure with reduced ejection fraction (HFrEF) patients prescribed sacubitril/valsartan during the 21-month period were included in this analysis. The average ejection fraction was 26%. The average age was 69 years. At baseline, 26.9% of patients were not on ACEi/ARB therapy and 13.5% were on target-dose therapy. After completing the uptitration process, the maximally tolerated dose of sacubitril/valsartan was 5.8% low-dose, 7.7% mid-dose, and 86.5% target-dose. Loop and thiazide diuretic use decreased significantly. There was a significant mean reduction in systolic blood pressure of 6 mmHg with no significant changes in serum creatinine, blood urea nitrogen, or potassium levels.


With close monitoring and follow-up, ARNi therapy was a safe alternative to ACEi/ARB therapy for chronic symptomatic HFrEF when initiated within a pharmacist clinic.



Angiotensin-converting enzyme inhibitor


American Heart Association


Angiotensin receptor blocker


Angiotensin receptor-neprilysin inhibitor


Confidence interval


Guideline-directed medical therapy


Heart failure with reduced ejection fraction


Hazard ratio


Level of Evidence


Left ventricular ejection fraction


Mineralocorticoid receptor antagonist


New York Heart Association


Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure


Renin–angiotensin–aldosterone system


Compliance with Ethical Standards

Conflict of interest

Elizabeth K. Pogge and Lindsay E. Davis declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Midwestern University College of Pharmacy-GlendaleGlendaleUSA

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