To determine appropriateness of sacubitril/valsartan usage within a tertiary institution, its efficacy and safety outcomes. 

In this retrospective drug use evaluation, patients prescribed with sacubitril/valsartan and followed up in our institution from May 2016 to December 2017 were included. Usage appropriateness was evaluated according to inclusion and exclusion criteria in PARADIGM-HF trial. Primary efficacy outcomes were all-cause and heart failure related hospitalizations, while safety outcomes were blood pressure and renal function. 

59 patients prescribed with sacubitril/valsartan were included. Mean age of study population was 61.41 (± 11.3) years, with majority being male (n=46, 78.0%). At initiation, 49 patients (83.1%) had LVEF ≤ 35% and 57 patients (96.6%) had eGFR  30 mL/min/1.73m². None had contraindications stated in product monograph. Majority of patients were initiated at doses of 25mg BD (n= 25, 42.4%) and 50mg BD (n= 25, 42.4%). 14 patients (23.7%) discontinued sacubitril/valsartan treatment, majority (n=8, 57.1%) due to non-medical reasons, e.g. costs and patient preference, 4 patients (28.6%) with symptomatic hypotension and 2 patients (14.3%) with worsening kidney function.

Among patients who received 12 months treatment, risks of all-cause and heart failure related hospitalizations were significantly reduced as compared to before initiation, with relative risk of 0.47 (0.30 – 0.74) and 0.30 (0.16 - 0.61) respectively. For safety outcomes at 12 months post-initiation, 8 patients (17.7%) had systolic blood pressure (SBP) of <95 mmHg, average SBP was significantly lower as compared to baseline (119.67 ± 20.2 vs. 114.16 ± 18.9 mmHg, p= 0.05). 2 patients (4.4%) had serum potassium level >5.2 mmol/L, and 1 patient (2.2%) with eGFR < 30 mL/min/1.73m². Average serum potassium level and eGFR were not significantly different from baseline.

Overall, use of sacubitril/valsartan within our institution was appropriate. Sacubitril/valsartan use was associated with decreased SBP, reduced all-cause and heart failure hospitalizations at 12 months.