(036) Efficacy of restricted prescribing protocol of sacubitril valsartan in Heart Failure with reduced Ejection Fraction (HFrEF) in a tertiary center in Saudi Arabia

Publication Number: 699

Background: sacubitril valsartan is a breakthrough advance in Heart failure management, Although of obvious clinical benefits, the rate of prescribing and integration into practice is not only low but also suboptimal to achieve recommended dose. We examined the effect of a restricted protocol on sacubitril valsartan prescribing patterns in a tertiary center in KSA.

Objectives: To determine the effect of restricted sacubitril valsartan protocol on time to maximum tolerated dose.

Methods: This is a single-center, retrospective cohort of patients with NYHA Class ΙΙ -ΙΙΙ heart failure with reduced ejection fraction, comparing Sacubitril valsartan restricted protocol to standard practice. This protocol was as follows (HFrEF Outpatient –Systolic BP > 110 and prescribed by heart failure team) followed up the patient for 12 months for efficacy and safety outcomes.

Results: A total of 78 patients were initially collected in, the protocol cohort (SV protocol; n= 58) from October 2018 to the end of December 2019 and compared to the standard cohort (standard, n=20). The primary endpoint of the study was the time to maximum tolerated dose. 78 Patients were included, no statistically significant differences between the two groups, Median age (IQR)is 56vs 57.5 years, Median weight (IQR) 82 vs 89 kg, Median S.cr (IQR) 1.1 vs 1.14 mg/dl, Median Crcl (IQR) = 85.18 vs 83.44. Target achieved in per protocol group was 63 % vs 25 % in standard practice, p=0.001.For the primary outcome, the time to achieve the target dose was a median (IQR) of 8 weeks per protocol vs. 24 in standard practice, p=0.024), No difference in the rate of AKI, hyperkalemia or symptomatic hypotension.

Conclusions: A Per protocol sacubitril valsartan practice was associated with significantly higher achievement in target doses and time to achieve target doses with no risk of increased adverse drug events.