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Heart, Lung and Circulation

The Impact of Sacubitril-Valsartan on Te Tairāwhiti (Gisborne and East Coast) Region

      Background

      Sacubitril-Valsartan (S-V) was approved in New Zealand under special authority on 01/10/18 for patients with heart failure reduced ejection fraction (HFrEF). We report our early experience with S-V in Te Tairāwhiti; a region with a high NZ Māori population and significant burden of heart failure (HF).

      Method

      A retrospective observational study of patients with HFrEF commenced on S-V under the cardiology CNS-led outpatient service between 01/02/2019-31/01/2020.

      Results

      A total of 62 patients were commenced on S-V over the 1-year period. The cohort was predominantly male (55/62, 89%) and of NZ Māori ethnicity (45/62, 73%), with a median age of 64 years (range 31-84 years) and high socioeconomic deprivation (44/62 (71%) with NZDep score 7-10). Comorbidities included hypertension (87%), atrial fibrillation (60%), chronic kidney disease (45%) and type 2 diabetes mellitus (32%). A total of 41 patients (66%) had heart failure attributed to ischaemic heart disease. Target dose was achieved and maintained in 29% (18/62), with similar proportions on median dose (18/62) and low dose (17/62) at 12 months. Mean time to maximum tolerated dose was 13.9 weeks (range, 2-51 weeks). Hypotension was the commonest reported side effect (29/62) which influenced up-titration. In patients who tolerated S-V, we noted improvement in HF symptom burden in the majority, with a notable reduction in NT-proBNP and improvement in LV function at 6 and 12 months.

      Conclusion

      Initiation of S-V for HFrEF in a CNS-led HF clinic has had a favourable impact on symptoms, biomarkers and LV function in the high-risk population of Te Tairāwhiti.
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