Author/Editor		Kapelios, Chris J.; Lainščak, Mitja; Savarese, Gianluigi; Laroche, Cécile; Seferović, Petar M.; Ruschitzka, Frank; Coats, Andrew J.; Anker, Stefan D.; Crespo-Leiro, Maria G.; Filippatos, Gerasimos; Strašek, Milena; Savnik-Iskra, Mojca; Ravnikar, Tinkara; Černič Šuligoj, Nataša; Komel, Jana; Fras, Zlatko; Jug, Borut; Glavič, Tanja; Lošić, Renata; Bombek, Mirko; Krajnc, Igor; Krunič, Barbara; Horvat, S.; Kovac, Dusan; Rajtman, Darko; Cenčič, Vid; Letonja, Mitja; Winkler, Robert; Valentinčič, Matej; Melihen Bartolič, Cvetka; Bartolić, Andrej; Pušnik, Maja; Kladnik, Majda; Slemenik-Pušnik, Cirila; Marolt, Apolon; Klen, Jasna; Drnovšek, Borut; Leskovar, Boštjan
Title		Sacubitril/valsartan eligibility and outcomes in the ESC-EORP-HFA Heart Failure Long-Term Registry
Type		članek
Vol. and No.		Letnik 21, št. 11
Publication year		2019
Volume		str. 1383-1397
ISSN		1879-0844 - European journal of heart failure
Language		eng
Abstract		AIMS: To assess the proportion of patients with heart failure and reduced ejection fraction (HFrEF) who are eligible for sacubitril/valsartan (LCZ696) based on the European Medicines Agency/Food and Drug Administration (EMA/FDA) label, the PARADIGM-HF trial and the 2016 ESC guidelines, and the association between eligibility and outcomes. METHODS AND RESULTS: Outpatients with HFrEF in the ESC-EORP-HFA Long-Term Heart Failure (HF-LT) Registry between March 2011 and November 2013 were considered. Criteria for LCZ696 based on EMA/FDA label, PARADIGM-HF and ESC guidelines were applied. Of 5443 patients, 2197 and 2373 had complete information for trial and guideline eligibility assessment, and 84%, 12% and 12% met EMA/FDA label, PARADIGM-HF and guideline criteria, respectively. Absent PARADIGM-HF criteria were low natriuretic peptides (21%), hyperkalemia (4%), hypotension (7%) and sub-optimal pharmacotherapy (74%); absent Guidelines criteria were LVEF>35% (23%), insufficient NP levels (30%) and sub-optimal pharmacotherapy (82%); absent label criteria were absence of symptoms (New York Heart Association class I). When a daily requirement of ACEi/ARB >10 mg enalapril (instead of >20 mg) was used, eligibility rose from 12% to 28% based on both PARADIGM-HF and guidelines. One-year heart failure hospitalization was higher (12% and 17% vs. 12%) and all-cause mortality lower (5.3% and 6.5% vs. 7.7%) in registry eligible patients compared to the enalapril arm of PARADIGM-HF. CONCLUSIONS: Among outpatients with HFrEF in the ESC-EORP-HFA HF-LT Registry, 84% met label criteria, while only 12% and 28% met PARADIGM-HF and guideline criteria for LCZ696 if requiring >20 mg and >10 mg enalapril, respectively. Registry patients eligible for LCZ696 had greater heart failure hospitalization but lower mortality rates than the PARADIGM-HF enalapril group.
Keywords		angiotensin receptor-neprilysin inhibitor eligibility prognosis LCZ696 registry Sacubitril/valsartan