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Poster
Tolerability profile and discontinuation causes of sacubitril/valsartan treatment in “real-life” patients with heart failure and reduced ejection fraction

M. Rizzo1, I. Colomer-Asenjo1, M. Sutil-Vega1, G. Cabello-Molina1, S. Marín-López1, F. Taibi-Hajjami1, C. Roca-Guerrero1, D. García-Vega1, M. Panelo-Rubio1, M. Bonastre-Thio1, A. Martínez-Rubio1 (1Sabadell (Barcelona) ES)


Aims: To describe the clinical characteristics, safety and tolerability profile, and discontinuation causes of sacubitril/valsartan (S/V) treatment in patients attending to an outpatient heart failure clinic.

Design & methods: We collected data from 119 consecutive patients between May and November 2018. Variables were collected baseline and post-S/V titration period.

Results: 64 patients (53,8%) were treated with S/V. At baseline, mean age was 63±10 years,76,6% men. Mean LVEF 28±6%. 39% ischemic etiology. 67% NYHA II. Median NT-proBNP 1176pg/ml (IQR 364-3945). Mean glomerular filtration rate (GFR) 71,7±20,6mL/min and potassium 4,4±0,4mEq/L. 84% of patients were treated with ACE inhibitors or ARBs, 95% beta-blockers and 86% mineralocorticoid receptor antagonists. Median titration time was 6,5 weeks (IQR 3-13,2). Target dose was achieved in 23 patients (40%). 24 (37,5%) needed dose reduction and 10 (15.6%) discontinued therapy. Causes for therapy discontinuation were hypotension defined as SBP <90 mmHg (<n=4, 6,2%), Potassium >5,5meq/L (n=2, 3,1%) and diarrhea (n=1, 1,6%). Patients who presented at least one adverse event were older, with lower SBP and GFR (all p<0.05). In a multivariate analysis a lower SBP (OR 0,94 95%CI 0.90-0,99) was the only variable independently associated with adverse events.

Conclusions: In our cohort, S/V has an acceptable tolerability profile. The proportion of patients who achieved target dose was lower than the reported in clinical trials, despite a longer titration time. Hypotension represents the main cause of reduction or discontinuation of S/V.

    
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Aims: To describe the clinical characteristics, safety and tolerability profile, and discontinuation causes of sacubitril/valsartan (S/V) treatment in patients attending to an outpatient heart failure clinic.

Design & methods: We collected data from 119 consecutive patients between May and November 2018. Variables were collected baseline and post-S/V titration period.

Results: 64 patients (53,8%) were treated with S/V. At baseline, mean age was 63±10 years,76,6% men. Mean LVEF 28±6%. 39% ischemic etiology. 67% NYHA II. Median NT-proBNP 1176pg/ml (IQR 364-3945). Mean glomerular filtration rate (GFR) 71,7±20,6mL/min and potassium 4,4±0,4mEq/L. 84% of patients were treated with ACE inhibitors or ARBs, 95% beta-blockers and 86% mineralocorticoid receptor antagonists. Median titration time was 6,5 weeks (IQR 3-13,2). Target dose was achieved in 23 patients (40%). 24 (37,5%) needed dose reduction and 10 (15.6%) discontinued therapy. Causes for therapy discontinuation were hypotension defined as SBP <90 mmHg (<n=4, 6,2%), Potassium >5,5meq/L (n=2, 3,1%) and diarrhea (n=1, 1,6%). Patients who presented at least one adverse event were older, with lower SBP and GFR (all p<0.05). In a multivariate analysis a lower SBP (OR 0,94 95%CI 0.90-0,99) was the only variable independently associated with adverse events.

Conclusions: In our cohort, S/V has an acceptable tolerability profile. The proportion of patients who achieved target dose was lower than the reported in clinical trials, despite a longer titration time. Hypotension represents the main cause of reduction or discontinuation of S/V.

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Marcelo Rizzo
ES-08208 Sabadell (Barcelona)
marcelo.rxo@gmail.com ) [session] => stdClass Object ( [id] => 1 [name] => Poster [date] => 2019-05-09 [start] => 00:00:00 [end] => 00:00:00 [abbr] => P [updated] => [created] => 0000-00-00 00:00:00 ) [formatted_authors] => M. Rizzo1, I. Colomer-Asenjo1, M. Sutil-Vega1, G. Cabello-Molina1, S. Marín-López1, F. Taibi-Hajjami1, C. Roca-Guerrero1, D. García-Vega1, M. Panelo-Rubio1, M. Bonastre-Thio1, A. Martínez-Rubio1 (1Sabadell (Barcelona) ES) [detail_url] => https://www.iscp2019.com/abstracts/presentation/21 )