Efficacy and tolerance evaluation of an ambulatory use of sacubitril/valsartan among patients with heart failure due to reduced ejection fraction

Introduction Heart failure due to reduced ejection fraction (HFrEF) has a real functional impact in daily life for patients. Improving the quality of life is one of the main goals when treating HF. The study PARADIGM-HF showed a 20% reduction of mortality and hospitalization for patients treated with sacubitril/valsartan (LCZ696). Objective The aim of our study was to evaluate patients with HFrEF after an ambulatory introducing of LCZ696. Method Thirty patients were included and evaluated at baseline, 2 weeks, 1, 3 and 6 months of follow-up. The efficacy and the tolerance of the treatment were judged on clinical, biological, echocardiographic and functional tests. Results At baseline, the mean age was 67 (39–89), with a majority of men (25; 83%) and ischemic cardiopathy (20; 67%). All patients had prior been hospitalized for HF at least once. Twenty-two (73%) patients were NYHA 2 and 8 (27%) were NYHA 3. NYHA class significantly improved during the follow up ( Fig. 1 ). Left ventricular ejection fraction (LVEF) significantly improved: 28% at baseline, 33% at M1, 36% at M3 and 38% at M6 ( P P P  = 0.0015). VO2 peak increased but not at a statistically significant level (15.3mL/kg/min at M0; 17.5ml/kg/min at M6; P  = NS). As predicted, NtproBNP level decreased (from 4313pg/mL at M0 to 1042pg/mL at M6; P Conclusion We observed a significant improvement in functional and echographic parameters among ambulatory patients with HFrEF after introduction of LCZ696. These results were obtained at the cost of a close monitoring to detect and manage side-effects, especially biological side effects.