Sacubitril/valsartan in heart failure patients with reduced ejection fraction: an analysis in the real-world prescription and treatment patterns

Objective To explore the real-world prescription and treatment patterns of sacubitril/valsartan(ARNI)in heart failure patients with reduced ejection fraction(HFrEF). Methods A total of 254 consecutive patients diagnosed as HFrEF and treated by ARNI were followed up for 6 months. According to the amount of ARNI during follow-up, the patients were divided into maintenance dose group(n=148), dose increase group(n=37)and dose reduction or withdrawal group(n=69). The dosage, echocardiographic parameters, systolic blood pressure and laboratory test level of three groups were compared before and after treatment, and the related influencing factors for ARNI titration were analyzed. Results 5.1% of patients titrated to the target dose. After 6 months of treatment, the left ventricular ejection fraction(LVEF)in the maintenance dose group and the dose increase group was significantly higher than that before treatment(△(-overx)=7.6%, 12.1%, P<0.01), and systolic blood pressure significantly reduced than those before treatment(△(-overx)=-16.4 mmHg, -7.6 mmHg, P<0.05). Multivariate Logistic regression analysis showed that readmission(OR=3.89, 95% CI=1.66~9.13, P<0.01)was an independent predictor of ARNI dose titration. Conclusion Most of the patients use ARNI at a maintenance level below the target dose level. Although the cardiac function has been improved significantly, the patients still miss the opportunity to increase the drug titration, and do not get the best benefit. At present, ARNI titration is often achieved through - readmission, so it is necessary to strengthen the education and follow-up management of patients with heart failure.