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. 2019 Aug;6(4):758-763.
doi: 10.1002/ehf2.12452. Epub 2019 May 14.

A per-protocol initiation of sacubitril/valsartan in an advanced heart failure disease management programme in the Middle East Gulf Region

Bassam Atallah  1 , Ziad G Sadik  1 , Mohamed Hisham  1 , Oussama Kalagieh  1 , Iman Hamour  2 , Guirgis Gabra  2 , Mosaad El Banna  2 , Medhat Soliman  2 , Antoine Cherfan  1 , Feras Bader  2
Affiliations

A per-protocol initiation of sacubitril/valsartan in an advanced heart failure disease management programme in the Middle East Gulf Region

Bassam Atallah et al. ESC Heart Fail. 2019 Aug.

Abstract

Aims: The aim of this study is to evaluate the utilization and success in therapy intensification after initiation of sacubitril/valsartan using a specified protocol within an advanced heart failure and transplant programme in the Middle East Gulf Region.

Methods and results: We studied a single-centre, retrospective cohort in a 364-bedded multi-speciality hospital located in the United Arab Emirates (February 2016 to July 2017). The advanced heart failure and transplant programme formulated an institutional protocol for initiation of sacubitril/valsartan with defined criteria for switching from angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB). Prescribing this drug is intended for patients with heart failure with reduced ejection fraction with left ventricular ejection fraction ≤40%. We excluded patients (i) with age below 18 years or (ii) initiated on sacubitril/valsartan from an outside hospital with or without follow-up in our outpatient clinic. We included 102 patients with an average initial dose of 78.9 ± 44.2 mg twice daily. Only 17 patients were on target doses of ACEI or ARB prior to switching to sacubitril/valsartan. Up-titration was successful in 55 patients during the follow-up period. In addition, 6.9% patients were hospitalized with heart failure exacerbation. In patients with elevated baseline serum potassium prior to initiating this medication, the serum potassium levels decreased post-initiation by 0.5 ± 0.3 mmol/L (P = 0.0008).

Conclusions: Initiating sacubitril/valsartan through a defined protocol selects for appropriate candidates and guides starting dose and titration. Overall, significant success can be achieved in replacing ACEI or ARB by sacubitril/valsartan in symptomatic heart failure with reduced ejection fraction patients.

Keywords: Angiotensin II and neprilysin inhibitor; Heart failure.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Angiotensin II and neprilysin inhibitor (ARNI) dose titration (percentage).
See this image and copyright information in PMC

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