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dc.contributor.authorDashwood, A
dc.contributor.authorVale, C
dc.contributor.authorLaher, S
dc.contributor.authorChui, F
dc.contributor.authorRheault, H
dc.contributor.authorGan, J
dc.contributor.authorWong, YW
dc.date.accessioned2020-07-21T00:35:58Z
dc.date.available2020-07-21T00:35:58Z
dc.date.issued2020
dc.identifier.issn1443-9506
dc.identifier.doi10.1016/j.hlc.2020.03.008
dc.identifier.urihttp://hdl.handle.net/10072/395651
dc.description.abstractBackground: Sacubitril/valsartan was shown to be superior to enalapril in the Prospective Comparison of angiotensin receptor neprilysin inhibitor with an angiotensin converting enzyme inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) study. However, the study design raised uncertainty about the potential real-world tolerability amongst less well selected cohorts. We aimed to examine the real-world tolerability and factors associated with successful titration of sacubitril/valsartan. Methods: We performed a retrospective single centre analysis in a tertiary referral centre of 235 consecutive patients prescribed sacubitril/valsartan between August 2016 and January 2018. Results: At baseline, our patients were younger, had lower baseline systolic blood pressure (SBP), reduced ischaemic aetiology and a higher rate of mineralocorticoids receptor antagonist compared to PARADIGM-HF. At last assessment, 120 patients (51%) reached target dose (97/103 mg bi-daily [BD]), 67 patients (29%) were stable on a mid-range dose (≥49/51 mg BD), 22 patients (9%) tolerated the low dose (24/26 mg BD) and 26 patients (11%) discontinued, comparable to PARADIGM-HF. Adverse effects were similar to PARADIGM-HF and hypotension remained the primary reason of sub-maximal titration. Several baseline characteristics were associated with successful titration to target dose including; higher baseline body mass index, systolic blood pressure (SBP) and sodium, male gender and treatment coordinated by multidisciplinary heart failure (HF) clinic. Conclusion: Comparable results to PARADIGM-HF in attaining target dose of sacubitril/valsartan and tolerability profile can be achieved in a real-world setting. Several baseline characteristics involving patient factors, markers of disease severity and systems of care predict successful titration to the target dose 97/103 mg BD.
dc.description.peerreviewedYes
dc.languageeng
dc.publisherElsevier BV
dc.relation.ispartofjournalHeart Lung and Circulation
dc.subject.fieldofresearchCardiorespiratory Medicine and Haematology
dc.subject.fieldofresearchPublic Health and Health Services
dc.subject.fieldofresearchcode1102
dc.subject.fieldofresearchcode1117
dc.subject.keywordsPARADIGM-HF
dc.subject.keywordsReal world
dc.subject.keywordsSacubitril/valsartan
dc.subject.keywordsTitration
dc.titleImpact of Patient and Model of Care Factors on Titration and Tolerability of Sacubitril/Valsartan: An Early Australian Real-World Experience
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationDashwood, A; Vale, C; Laher, S; Chui, F; Rheault, H; Gan, J; Wong, YW, Impact of Patient and Model of Care Factors on Titration and Tolerability of Sacubitril/Valsartan: An Early Australian Real-World Experience, Heart Lung and Circulation, 2020
dcterms.dateAccepted2020-03-10
dc.date.updated2020-07-21T00:34:01Z
gro.description.notepublicThis publication has been entered as an advanced online version.
gro.hasfulltextNo Full Text
gro.griffith.authorDashwood, Alexander M.


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