Sacubitril/valsartan in patients with symptomatic chronic heart failure with reduced ejection fraction

Background: Sacubitril/valsartan is a combination drug therapy for heart failure (HF) patients that has been shown to reduce mortality and hospitalisation. Aims: To explore clinically relevant real-life patient data regarding prescribing of sacubitril/valsartan for HF patients in three hospitals, in accordance with national guidelines. Methods: A retrospective multicentre study in three large UK hospital Trusts based in the West Midlands. Findings: A total of 118 symptomatic chronic HF patients with reduced ejection fraction were included in the study. A high proportion of prescribers adhered to NICE guidelines for treatment with sacubitril/valsartan; 99% of patients had a New York Heart Association functional class of at least II; 82% had a left ventricle ejection fraction of under 35%; 100% received an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker before commencing sacubitril/valsartan. The mean age of men and women at the three hospitals was 65 and 59 years, respectively. The proportion of men prescribed sacubitril/valsartan was greater than women: 80% compared to 20%, respectively. The majority of patients on the therapy were white British (65%). Total prescribing of sacubitril/valsartan at the three hospitals was 295 patients, lower than expected. Conclusion: The prescribing of sacubitril/valsartan at the Trusts generally adhered to NICE guidance; however, the prescribing rate was lower than expected compared with the NICE resource tool. Further investigations into the safety and scope of application of sacubitril/valsartan are required to match the prescribing of sacubitril/valsartan with eligible patients who could benefit from the medication.