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• W3204251667 abstract "<h3>Introduction</h3> Secubitril/Valsartan (SV) has become a standard front line therapy for patients with heart failure with reduced ejection fraction (HFrEF) with a left ventricular ejection fraction (LVEF) less than or equal to 35%. It has been shown to reduce heart failure hospitalisations, death and improve quality of life. In addition, it has been shown to have an impact on improving LVEF and reducing sudden cardiac death independent of implantable cardiac defibrillator (ICD) protection. These observations indicate that SV might have an impact on prophylactic ICD need in this syndrome. To date there are few if any data on this issue in a standard community population. <h3>Aim</h3> The aim of this study is to assess whether SV therapy reduced the requirement for prophylactic ICD use in patients with HFrEF. <h3>Method</h3> In an ongoing audit of the impact of SV in a community heart failure population we are analysing the impact of this agent on the change in LVEF comparing the baseline value, determining the need for therapy with SV, with a value taken a minimum of three months following the last titration step with this agent. Patients who would meet the criteria for prophylactic ICD as defined by the European Society of Cardiology would require symptomatic heart failure (NYHA Class II-III) in addition to an LVEF of 35% or less despite at least three months of optimal medical therapy. Effective avoidance of need as a result of SV use was defined as moving above the 35% cut-off with at least a 5% change in value. <h3>Result</h3> In an ongoing analysis of 507 patients, 341 to date have completed titration and have undergone a post titration follow up assessment of LVEF. The mean age of the population is 73 years old (IQR 59-77yrs) with 70% being male. 38% had atrial fibrillation. All had been treated with ACEI/ARB with 40% of these achieving target dose therapy prior to use of SV. 90% were on a beta-blocker with 13% at target dose and 69% were on a mineralocorticoid receptor antagonist, with 38% at target dose. The average LVEF for the population at baseline was 28.1% (SD 7.36%). At follow-up the LVEF climbed to an average of 34.7% (SD 11.45%). Overall 51% of patients achieved an improvement in EF of 5% or more with SV, with the average improvement being 6.6%. 10.85% of patients experienced a reduction in EF of 5% or more, with the average reduction being 8.9%. 39% of the population did not see a significant change in EF. 32.5% of the cohort demonstrated an increase in at least 5% in LVEF and went above the 35% cut-off point thereby moving above the value for prophylactic ICD. <h3>Conclusion</h3> These findings support previous observations in demonstrating a significant improvement in LVEF with SV in a population receiving effective standard background therapies. A novel and important observation from these data is that the improvement in LVEF removes approximately a third of the cohort from the need for a prophylactic ICD. This finding has important clinical and health economic implications further strengthening the role of this agent in HFREF management." @default.
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• W3204251667 date "2021-10-01" @default.
• W3204251667 modified "2023-09-26" @default.
• W3204251667 title "43 Sacubitril/Valsartan results in a significant reduction in the need for prophylactic impantable cardiac defibrillator in a heart failure with reduced ejection fraction population" @default.
• W3204251667 doi "https://doi.org/10.1136/heartjnl-2021-ics.43" @default.
• W3204251667 hasPublicationYear "2021" @default.
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