Initiation and titration of sacubitril/valsartan in different types of centers

Abstract Introduction and objectives Sacubitril/valsartan (SV) is recommended in patients with heart failure and reduced left ventricular ejection fraction. However, the characteristics of the centers included in the pivotal clinical trial differ from real life. The present study aims to analyze the clinical profile of patients treated with SV according to hospital type and the potential role of these differences in drug safety and effectivity. Methods Prospective multicenter registry that included outpatients treated with SV. We compared baseline characteristics and treatments, drug titration, and data at 7-months follow-up according to hospital type. Results From 427 patients, 81 (19%) were included in medium/small size hospitals, 204 (48%) in heart transplant program centers and 142 (33%) in hospitals with ≥1000 beds without heart transplant program. A low starting dose of SV (50 mg bid) was more frequent in medium/small size hospitals than in hospitals with ≥1000 beds (51 [63.0%] vs 151 [43.6%] patients, P = .008). At 7 months, SV had been withdrawn more frequently in medium/small size hospitals than in hospitals ≥1000 beds (15 [18.5%] vs 34 [9.8%] patients, P = .001], in spite of a similar rate of adverse events (23 [28.4%)] vs 99 [28.6%] patients, P = .94). Conclusion In our registry, the use of SV in real life showed a low rate of events during follow-up. The above suggests that this drug is safe and beneficial in different clinical profiles of patients but drug withdrawal is more frequent in medium/small size hospitals.