Please use this identifier to cite or link to this item:
http://hdl.handle.net/1942/30402
Title: | Determinants of maximal dose titration of sacubitril/valsartan in clinical practice | Authors: | MARTENS, Pieter Verluyten, Lina Van de Broek, Heleen Somers, Frauke DAUW, Jeroen DUPONT, Matthias MULLENS, Wilfried |
Issue Date: | 2021 | Publisher: | TAYLOR & FRANCIS LTD | Source: | Acta cardiologica (Imprimé), 76 (1), p. 20-29 | Abstract: | Background: Little information is available about the tolerability of uptitration to the maximal dose of sacubitril/valsartan and the predictors and clinical correlates of achieving such a dose. Methods: All consecutive heart failure patients with reduced ejection fraction (HFrEF) who received sacubitril/valsartan for a class-IB indication in a tertiary heart failure clinic were retrospectively analysed. Predictors of maximal uptitration including associated changes in clinical parameters were assessed in patients with at least 1 follow-up. Results: A total of 401 HFrEF-patients received sacubitril/valsartan. Uptitration was possible in 41% and up to 32% of patients tolerated the maximal dose of sacubitril/valsartan. Younger age (HR = 0.862; CI = 0.751-0.989), higher systolic-blood-pressure (HR = 1.077; CI = 1.014-1.137), lower serum creatinine (HR = 0.064; CI = 0.005-0.822), and higher previous dose of renin-angiotensin-system-inhibitors (RASi [HR = 1.065; CI = 1.016-1.115]) independently predicted a higher odds of tolerating a maximal dose of sacubitril/valsartan. Patients who were seen more frequently in a structured heart failure clinic were also more likely to receive a maximal dose (p = .038). Patient assigned to the maximal dose, were more often able to reduce their loop diuretic dose (p = .001) and more often had an increase in serum creatinine (p = .011), without a higher risk for hyperkalemia (p = .524). An improvement in New York Heart Association class and the rate of heart failure hospitalisations was observed in all patients, independent of the sacubitril/valsartan dose. Conclusion: Uptitration to the maximal dose of sacubitril/valsartan is possible in up to 32% of real-world HFrEF-patients in our cohort, which relates to both patient characteristics' as well as heart failure care-related factors. | Notes: | Martens, P (reprint author), Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium. pieter_martens@icloud.com |
Other: | Martens, P (reprint author), Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium pieter_martens@icloud.com | Keywords: | Heart failure;sacubitril/valsartan;dosing;outcome;guidelines;real world evidence | Document URI: | http://hdl.handle.net/1942/30402 | ISSN: | 0001-5385 | e-ISSN: | 1784-973X | DOI: | 10.1080/00015385.2019.1686226 | ISI #: | WOS:000495010000001 | Rights: | 2019 Belgian Society of Cardiology | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2020 |
Appears in Collections: | Research publications |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
pieter martens 2019.pdf Restricted Access | Published version | 1.42 MB | Adobe PDF | View/Open Request a copy |
SCOPUSTM
Citations
2
checked on Sep 5, 2020
WEB OF SCIENCETM
Citations
10
checked on Oct 13, 2024
Page view(s)
46
checked on Jul 22, 2022
Download(s)
4
checked on Jul 22, 2022
Google ScholarTM
Check
Altmetric
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.