What proportion of patients with chronic heart failure are eligible for sacubitril-valsartan?

Pellicori, P. , Urbinati, A., Shah, P., MacNamara, A., Kazmi, S., Dierckx, R., Zhang, J., Cleland, J. G.F. and Clark, A. L. (2017) What proportion of patients with chronic heart failure are eligible for sacubitril-valsartan? European Journal of Heart Failure, 19(6), pp. 768-778. (doi:10.1002/ejhf.788) (PMID:28244205)

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Abstract

Aims: The PARADIGM-HF trial showed that sacubitril–valsartan, an ARB–neprilysin inhibitor, is more effective than enalapril for some patients with heart failure (HF). It is uncertain what proportion of patients with HF would be eligible for sacubitril–valsartan in clinical practice. Methods and results: Between 2001 and 2014, 6131 patients consecutively referred to a community HF clinic with suspected HF were assessed. The criteria required to enter the randomized phase of PARADIGM-HF, including symptoms, NT-proBNP, and current treatment with or without target doses of ACE inhibitors or ARBs, were applied to identify the proportion of patients eligible for sacubitril–valsartan. Recognizing the diversity of clinical opinion and guideline recommendations concerning this issue, entry criteria were applied singly and in combination. Of 1396 patients with reduced left ventricular ejection fraction (≤40%, HFrEF) and contemporary measurement of NT-proBNP, 379 were on target doses of an ACE inhibitor or ARB at their initial visit and, of these, 172 (45%) fulfilled the key entry criteria for the PARADIGM-HF trial. Lack of symptoms (32%) and NT-proBNP <600 ng/L (49%) were common reasons for failure to fulfil criteria. A further 122 patients became eligible during follow-up (n = 294, 21%). However, if background medication and doses were ignored, then 701 (50%) were eligible initially and a further 137 became eligible during follow-up. Conclusions: Of patients with HFrEF referred to a clinic such as ours, only 21% fulfilled the PARADIGM-HF randomization criteria, on which the ESC Guidelines are based; this proportion rises to 60% if background medication is ignored.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Pellicori, P., Urbinati, A., Shah, P., MacNamara, A., Kazmi, S., Dierckx, R., Zhang, J., Cleland, J. G.F., and Clark, A. L.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:27 February 2017
Copyright Holders:Copyright © 2017 Wiley
First Published:First published in European Journal of Heart Failure 19(6): 768-778
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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