2019, Volume 26, Supplement 1: Advances in the treatment of chronic heart failure with reduced ejection fraction in real-world settings

This article will contribute to a 'Learning with reflection' CPD activity Sacubitril/valsartan has been widely used for the treatment of chronic heart failure with reduced left ventricular ejection fraction (HFrEF), following the publication of updated guidance from the National Institute for Health and Care Excellence in 2016. This series of articles summarises the current evidence base for the use of sacubitril/valsartan, and reviews initial experience of initiating this treatment from heart failure teams at major centres around the UK....

This article will contribute to a 'Learning with reflection' CPD activity The PARADIGM-HF trial demonstrated that sacubitril/valsartan reduces morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF) and that it improves quality of life at acceptable levels of cost. This review will examine the guidelines and secondary analyses of PARADIGM-HF that may help the heart failure team, responsible for a patient’s care, make an informed decision on the appropriate use of sacubitril/valsartan in clinical practice....

This article will contribute to a 'Learning with reflection' CPD activity Sacubitril/valsartan has been approved for use by the National Institute for Health and Care Excellence (NICE) as an alternative to angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) in adult patients with symptomatic chronic heart failure with reduced ejection fraction (HFrEF). We report our clinical experience of the use of sacubitril/valsartan in 140 patients with HFrEF in a retrospective analysis from a major UK centre. Up-titration to the target dose was achieved in 55% (n=77), and New York Heart Association class improved in 31% (n=43). A symptomatic fall in systolic blood pressure of >10 mmHg prevented up-titration in 31% (n=44). Heart failure (HF)-related admissions occurred in 6% of patients at both six months (n=8/140) and one year (n=4/68), with a mortality of 4% (n=5/140) and 7% (n=5/68), respectively. Renal function worsened in 10.7% (n=15/140). Sacubitril/valsartan was withdrawn for adverse events in 8% (n=11/140). Sacubitril/valsartan was well tolerated and improved HF outcomes and symptoms, but 45% (n=63/140) were unable to achieve the target dose....

This article will contribute to a 'Learning with reflection' CPD activity Sacubitril/valsartan (formerly LCZ696) is recommended for adult patients with symptomatic chronic heart failure with reduced ejection fraction (HFrEF) already established on conventional heart failure therapy. Large numbers of patients are potentially eligible for this drug, but patient monitoring and lack of experience of drug tolerability may mean some are not considered. We describe our trainee-led service to deliver sacubitril/valsartan therapy in the setting of limited extra resources. This pathway was delivered successfully by working closely with primary care. Up-titration to the target dose level of sacubitril/valsartan (given alongside other standard-of-care treatments for HFrEF) was possible in two-thirds of patients. Tolerability was generally good, with the majority achieving successful dose optimisation of sacubitril/valsartan....

This article will contribute to a 'Learning with reflection' CPD activity This short review outlines how sacubitril/valsartan has been incorporated into the care of patients by the heart failure team at Medway Community Healthcare, since 2016. It also discusses the structural support infrastructure available in Medway, from the attitudes of the team, the setting up of local guidance and operating procedures, to the multi-disciplinary team (MDT) meetings, and availability of supporting consultant cardiologists. Together this has enabled us to successfully change our practices and build confidence in how and when to use this drug....

This article will contribute to a 'Learning with reflection' CPD activity Guidance from the UK National Institute for Health and Care Excellence changed in 2016 to support the therapeutic use of sacubitril/valsartan in adult patients with symptomatic chronic heart failure with reduced ejection fraction. We review the way the drug has since been initiated by heart failure nurse specialists in Northern Ireland, the management of its side effects and its positive effect on patient outcomes....