The Impact of Sacubitril/Valsartan on Heart Failure Patient with Reduced Left Ventricular Ejection Fraction: Single Center Retrospective Study in Saudi Arabia

Sultan Al Raddadi,1– 3 Majed Almutairi,1,3 Kholoud AlAamer,1,3 Abdulmahsen Alsalman,3,4 Maram Albalawi,5 Meshary Almeshary,1,3 Hisham A Badreldin,1,2,6 Hind Almodaimegh1– 3 1Department of Pharmaceutical Care, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia; 2Department of Pharmacy Practice, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Department of Research Office, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 4Department of Cardiology Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 5Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 6Department of Saudi Biobank, King Abdullah International Medical Research Center, Riyadh, Saudi ArabiaCorrespondence: Sultan Al Raddadi, Department of Pharmaceutical Care, King Abdulaziz Medical City-Riyadh, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia, Email [email protected]: Sacubitril/valsartan (S/V) is used in managing heart failure with reduced ejection fraction (HFrEF), reducing morbidity and mortality while improving symptoms and prognosis. This study aims to evaluate the effectiveness of S/V in patients with reduced left ventricular ejection fraction (LVEF) and its safety.Methods: This retrospective cohort study included adult patients aged ≥ 18 years diagnosed with HFrEF, receiving S/V, and followed up at a tertiary hospital in Riyadh. Primary outcomes included improvements in LVEF on echocardiography and the number of hospitalizations due to acute decompensated heart failure (ADHF). Secondary outcomes assessed the safety profile of S/V. Multinomial logistic regression analysis was performed with statistical significance set at P < 0.05.&#x202FResults: The study included 107 patients: 80 with LVEF < 30% and 27 with LVEF 30– 40%. Six-month follow-up, LVEF improvement was categorized into three groups: no improvement, LVEF increased by 1 to < 10 points, and LVEF increased by ≥ 10 points. The LVEF was similar across groups (P = 0.59). Although hospitalizations due to ADHF were not significantly different between groups, they numerically decreased after initiating S/V (P = 0.1). S/V was generally well tolerated.Conclusion: This study suggests no significant benefit from S/V regarding LVEF improvement. It is recommended that heart failure clinics assess and titrate S/V to the maximum tolerated dose.Keywords: heart failure with reduced ejection fraction, left ventricular ejection fraction, angiotensin receptor neprilysin inhibitors, sacubitril/valsartan