Aims 

Practice guidelines recommend sacubitril/valsartan for heart failure with reduced ejection fraction. The aim of our study was to describe the use of sacubitril/valsartan in real-world clinical practice to help identify patients best able to tolerate titration to higher doses.

Methods 

We retrospectively analyzed clinical data for 201 patients with heart failure with reduced ejection fraction prescribed sacubitril/valsartan at our heart failure clinic (Centro Cardiologico Monzino) between September 2016/December 2018. Patients had a mean age of 67.2 years, mean left ventricular ejection fraction of 30.1%, New York Heart Association class II (65%), class III (35%), and poor cardiopulmonary exercise capacity. Median 2-year risk of death/urgent cardiac transplantation was 8.9% [Metabolic Exercise Cardiac Kidney Index (MECKI) score].

Results 

After a median follow-up of 230 (interquartile interval: 105–366) days, 57 patients achieved higher-dose sacubitril/valsartan, 103 tolerated medium/low doses, nine died, and 20 interrupted treatment. The highest dose of sacubitril/valsartan was reached by younger patients with better hemoglobin (Hb) levels, renal function, and blood pressure (BP). Patients continuing on sacubitril/valsartan had significantly higher serum Hb and sodium, better BP, and lower MECKI scores than patients who discontinued treatment or died during follow-up. Our patients were older and frailer than those in the pivotal PARADIGM-HF trial.

Conclusion 

In our experience, more than one-third of the patients were able to tolerate the higher dose of sacubitril/valsartan, and these patients were younger, had higher Hb, and better BP and renal function. MECKI score stratification was useful to discriminate patients who continued treatment from those who did not. Future prospective studies should test if these clinical variables can guide the up-titration of sacubitril/valsartan.

中文翻译：

---

屈卡普利/缬沙坦在现实世界中患有心力衰竭和射血分数降低的患者中的使用

目的 

实践指南推荐sacubitril /缬沙坦用于心脏衰竭减少射血分数。我们研究的目的是描述在实际的临床实践中使用沙必比尔/缬沙坦的用途，以帮助确定最能耐受高剂量滴定的患者。

方法 

我们回顾性分析了2016年9月至2018年12月间在我们的心力衰竭诊所（Centro Cardiologico Monzino）开出的sacubitril /缬沙坦处方射血分数降低的201例心力衰竭患者的临床数据。患者平均年龄为67.2岁，平均左心室射血分数30.1％，纽约心脏协会II级（65％），III级（35％）和心肺运动能力差。2年死亡/紧急心脏移植的中位风险为8.9％[代谢性运动心脏肾脏指数（MECKI）评分]。

结果 

中位随访230天（四分位间隔：105-366天）后，有57例患者获得了更高剂量的沙比特利/缬沙坦，103例耐受中/低剂量，9例死亡，20例中断治疗。血红蛋白（Hb）水平，肾功能和血压（BP）较好的年轻患者可达到最高的沙比特比/缬沙坦剂量。与终止治疗或在随访期间死亡的患者相比，继续接受沙必比尔/缬沙坦治疗的患者血清Hb和钠含量明显更高，血压更高，而MECKI评分更低。我们的患者比关键的PARADIGM-HF试验中的患者年龄更大且更虚弱。

结论 

根据我们的经验，超过三分之一的患者能够耐受更高剂量的沙必特/缬沙坦，这些患者更年轻，Hb更高，血压和肾功能更好。MECKI评分分层有助于区分继续治疗的患者和未继续治疗的患者。未来的前瞻性研究应测试这些临床变量是否可以指导沙必比/缬沙坦的滴定。