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2018 ; 5
(2
): 337-343
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Eligibility of sacubitril-valsartan in a real-world heart failure population: a
community-based single-centre study
#MMPMID29345425
Norberg H
; Bergdahl E
; Lindmark K
ESC Heart Fail
2018[Apr]; 5
(2
): 337-343
PMID29345425
show ga
AIMS: This study aims to investigate the eligibility of the Prospective
Comparison of Angiotensin Receptor-Neprilysin Inhibitor (ARNI) with ACE inhibitor
to Determine Impact on Global Mortality and Morbidity in Heart Failure
(PARADIGM-HF) study to a real-world heart failure population. METHODS AND
RESULTS: Medical records of all heart failure patients living within the
catchment area of Umeå University Hospital were reviewed. This district consists
of around 150 000 people. Out of 2029 patients with a diagnosis of heart failure,
1924 (95%) had at least one echocardiography performed, and 401 patients had an
ejection fraction of ?35% at their latest examination. The major PARADIGM-HF
criteria were applied, and 95 patients fulfilled all enrolment criteria and thus
were eligible for sacubitril-valsartan. This corresponds to 5% of the overall
heart failure population and 24% of the population with ejection fraction ? 35%.
The eligible patients were significantly older (73.2 ± 10.3 vs.
63.8 ± 11.5 years), had higher blood pressure (128 ± 17 vs. 122 ± 15 mmHg), had
higher heart rate (77 ± 17 vs. 72 ± 12 b.p.m.), and had more atrial fibrillation
(51.6% vs. 36.2%) than did the PARADIGM-HF population. CONCLUSIONS: Only 24% of
our real-world heart failure and reduced ejection fraction population was
eligible for sacubitril-valsartan, and the real-world heart failure and reduced
ejection fraction patients were significantly older than the PARADIGM-HF
population. The lack of data on a majority of the patients that we see in
clinical practice is a real problem, and we are limited to extrapolation of
results on a slightly different population. This is difficult to address, but
perhaps registry-based randomized clinical trials will help to solve this issue.