Int J Heart Fail.  2022 Oct;4(4):193-204. 10.36628/ijhf.2022.0015.

Real-World Usage of Sacubitril/ Valsartan in Korea: A Multi-Center, Retrospective Study

• Park JJ
• Lee SE
• Cho HJ
• Choi JO
• Yoo BS
• Kang SM
• Wang HC
• Lee S
• Choi DJ

• KMID: 2536295
• DOI: http://doi.org/10.36628/ijhf.2022.0015

Abstract

Background and Objectives
Differences in drug prescriptions exist between clinical trials and real-world practice. We evaluated the real-world treatment patterns of sacubitril/ valsartan in Korean patients with heart failure (HF).
Methods
In this retrospective, multicenter cohort study, 600 patients with HF with reduced left-ventricular ejection fraction (LVEF <40%) with ≥1 sacubitril/valsartan prescription were identified by reviewing patient-level medical records at six academic tertiary hospitals in Korea between February 2017 and April 2019.
Results
At baseline, 59.2%, 28.3%, 4.8%, and 7.7% of the patients received low (50 mg bid), moderate (100 mg bid), target (200 mg bid), and unconventional dose of sacubitril/valsartan, respectively. Patients with low and moderate doses experienced either ‘no-titration’ (39.8%) or ‘stable up-titration’ (41.5%). At 12 months, 31.7%, 28.5%, 24.8%, and 15% received low, moderate, target doses, and unconventional dose, respectively. On follow-up, 31 (5.2%) patients discontinued sacubitril/valsartan. The time-averaged N-terminal pro-B-type natriuretic peptide (NT-proBNP) level decreased from 879.6 to 406 pg/mL (ratio, 0.5; 95% confidence interval, 0.4–0.5). The mean LVEF increased by 10.4±12.2% from 27.2±5.8 to 36.3±11.1%, whereas LV end-diastolic volume index decreased by 18.7±26.1 mL/m ² from 114.5±37.7 mL/m ² to 98.9±42.3 mL/m ² at baseline and follow-up, respectively.
Conclusions
In real-world practice, 95% patients started with low and moderate doses of sacubitril/valsartan. Many patients experienced dose up-titration during follow-up; 30% reached the target dose. Cardiac reverse remodelling was reflected by a profound NT-proBNP level and LV size reduction, and LVEF increment. This study confirms the gap in treatment patterns between clinical trials and real-world practice.

Keyword

Heart failure; Treatment pattern; Dosage; Remodeling