Dose titration of sacubitril/valsartan for heart failure with reduced ejection fraction: a real‐world study

Abstract Aims The study aims to explore the real‐world titration patterns of sacubitril/valsartan in a chronic heart failure (HF) follow‐up management system and the effect on the recovery of ventricular remodelling and cardiac function in China. Methods and results This is a single‐centre, observational study of 153 adult outpatients with HF and reduced ejection fraction who were managed in the chronic HF follow‐up management system and prescribed with sacubitril/valsartan from August 2017 to August 2021 in China. All patients tried to titrated sacubitril/valsartan to the tolerant dose during follow‐up. The primary outcome was the proportion of patients who reached and maintained the target dose of sacubitril/valsartan. The main secondary outcomes were the changes in left atrium diameter, left ventricular end‐diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) from baseline to 12 months. Among the patients, 69.3% were male, with a median age of 49 years. The baseline systolic blood pressure (SBP) was 117.6 ± 18.3 mmHg before starting the treatment of sacubitril/valsartan. Benefiting from the management system, 117 (76.5%) patients achieved the target dose of sacubitril/valsartan, and the median time to reach the target dose was 3 (IQR 1–5) months. Advanced age and lower SBP may be predictors of failure to reach the target dose. Compared with baseline, standard treatment resulted in a pronounced improvement in left ventricular geometry and cardiac function. The patients showed a significant increase in LVEF [28 (IQR 21–34) % vs. 42 (IQR 37.0–54.3) %, P < 0.001], with a great reduction in left atrium diameter [45 (IQR 40.3–51.0) mm vs. 41 (IQR 37.0–45.3) mm, P < 0.001] and LVEDD [65 (IQR 60.0–70.3) mm vs. 55 (IQR 52–62) mm, P < 0.001] during 12 month follow‐up. Of patients, 36.5% had a LVEF ≥50%, 54.1% had LVEF >40%, and 81.1% experienced an increase in LVEF of ≥10%. After 12 month follow‐up, the proportion of patients with New York Heart Association classification I or II increased from 41.8% to 96.4%. Additionally, there was a significant improvement in N‐terminal pro‐B‐type natriuretic peptide ( P < 0.001). At Month 12, 50% of patients achieved the target dose of beta‐blockers. No serious adverse events caused by sacubitril/valsartan were observed during the follow‐up. Conclusions Optimising HF follow‐up management was essential and effective in a real‐world clinical setting; the majority could reach the target dose of sacubitril/valsartan within the management system and achieve a remarkable improvement in cardiac function and ventricular remodelling.