• Savvy Nandal, Chee Loong Chow, Vikki Hannah, Gautam Vaddadi, and William Van Gaal.
• The Cardiology Department, The Northern Hospital, Melbourne, Victoria, Australia.
• Intern Med J. 2021 Jan 1; 51 (1): 87-92.

BackgroundHeart failure (HF) is a major cause of morbidity and mortality. Sacubitril/valsartan has demonstrated reductions in HF hospitalisation, and all-cause mortality in patients with heart failure with reduced ejection fraction.AimsTo assess the tolerability and efficacy of sacubitril/valsartan in an intention to treat patient cohort.MethodsSixty-five patients who were commenced on sacubitril/valsartan in 2017 at a major metropolitan centre in Victoria were retrospectively audited. Clinical outcomes and quality of life scores were obtained pre and post sacubitril/valsartan commencement through phone and regular clinic follow up, 6-12 months after commencement of sacubitril/valsartan.ResultsFourteen percent of patients were able to achieve maximal dose (97/103 mg twice daily) whilst 37% remained on 49/51 mg and 23% on 24/26 mg. The mean systolic blood pressure reduced from 118 ± 18 mmHg to 109 ± 15 mmHg with symptomatic hypotension (30%) being the most common side-effect leading to dose reduction or drug cessation. Left ventricular ejection fraction improved from 29.1 ± 9.7% to 33.8 ± 9.9% (P < 0.05) on drug. There was also a significant improvement in quality of life scores; EQ5D-VAS 40 pre versus 67 post sacubitril/valsartan (P < 0.05), and New York Heart Association class (P < 0.05). Importantly, 10 patients lost an existing indication for device based therapy after treatment with sacubitril/valsartan.ConclusionsSacubitril/valsartan is a much needed therapeutic advancement in the treatment of HF. Our study indicates it is well tolerated with improvements in cardiac function and symptoms. Sacubitril/valsartan could redefine the definition of 'optimal medical therapy' when assessing patients for device based therapies.© 2020 Royal Australasian College of Physicians.

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