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

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Abstract

Objective

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

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

ACEi:

Angiotensin-converting enzyme inhibitor

AHA:

American Heart Association

ARB:

Angiotensin receptor blocker

ARNi:

Angiotensin receptor-neprilysin inhibitor

CI:

Confidence interval

GDMT:

Guideline-directed medical therapy

HFrEF:

Heart failure with reduced ejection fraction

HR:

Hazard ratio

LOE:

Level of Evidence

LVEF:

Left ventricular ejection fraction

MRA:

Mineralocorticoid receptor antagonist

NYHA:

New York Heart Association

PARADIGM-HF:

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

RAAS:

Renin–angiotensin–aldosterone system

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Funding

No external funding was used in the preparation of this manuscript.

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Authors and Affiliations

  1. Midwestern University College of Pharmacy-Glendale, 19555 North 59th Avenue, Glendale, AZ, 85308, USA

    Elizabeth K. Pogge & Lindsay E. Davis

Authors
  1. Elizabeth K. Pogge
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  2. Lindsay E. Davis
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Corresponding author

Correspondence to Lindsay E. Davis.

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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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Pogge, E.K., Davis, L.E. Evaluating the Safety and Tolerability of Sacubitril/Valsartan for HFrEF Managed Within a Pharmacist Clinic. Am J Cardiovasc Drugs 18, 143–151 (2018). https://doi.org/10.1007/s40256-018-0264-5

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  • DOI: https://doi.org/10.1007/s40256-018-0264-5

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