Even when patients do not exhibit apparent symptoms, cardiac damage is constantly occurring1
Modest changes in LVEF may be clinically important; the adjusted risk of CV-related mortality increases two-to eight-fold beyond a >10-unit decline in LVEF (P<0.001).2
deterioration for cardiac myocytes in failing human hearts compared with healthy hearts3
each year where HF is the primary diagnosis. Around half of those diagnosed with HF in the UK die within 5 years of their diagnosis4
greater risk of death in the first month after just one HF hospitalisation in comparison with non-hospitalised patients5,6
of HFrEF patients may experience sudden cardiac death, even when their symptoms have not worsened7
A multi-pathway, disease modifying approach can optimally target cardiac damage, reversing it and subsequently improving disease trajectory8
To delay clinical progression, extend survival, and improve QoL, the current expert-recommended therapeutic approach is to start with ENTRESTO® in chronic HFrEF patients9,10
Despite recommendations, the use of ENTRESTO is significantly lower than expected by NICE11
ENTRESTO significantly improved mortality and morbidity outcomes, showing greater risk reduction in CV death and HF hospitalisations while generally demonstrating comparable safety vs ACEi (enalapril) in all stages of the HFrEF patient journey.12–14
However, in the UK...
of HFS cardiologists rarely prescribe ENTRESTO15
of non-HFS cardiologists rarely prescribe ENTRESTO15
of ENTRESTO prescriptions are intended for progressing/severe patients15
Observed and expected use of sacubitril/valsartan in England11
Sacubitril/valsartan – observed use and range of expected use in primary and secondary care prescribing from January 2019 to December 2020*
The annual volume of medicine used was between 70% and 75% lower than expected11
ENTRESTO is indicated in adult patients for the treatment of symptomatic chronic heart failure with reduced ejection fraction.14
*For the 12-month period from January 2020 to December 2020, the graph shows the expected and observed use and the ratio between them. Defined daily doses were not available for this formulation, so tablets were used to measure uptake.
ACEi, angiotensin-converting enzyme inhibitor; ADDs, actual daily doses; BB, beta blocker; CaReMe UK, Cardio-Renal-Metabolic Partnership UK; CV, cardiovascular; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; HFS, heart failure services; LVEF, left ventricular ejection fraction; MoA, mode of action; MRA, mineralocorticoid receptor antagonist; NICE, The National Institute for Health and Care Excellence; QoL, quality of life; RAAS, renin-angiotensin-aldosterone system; SGLT2i, sodium glucose cotransporter-2 inhibitor.
- Mann DL, Bristow MR. Circulation 2005;111(21):2837–2849.
- Strange G, et al. Eur J Heart Fail 2021;23(4):555–563.
- Konstantinidis K, Whelan RS, Kitsis RN. Thromb Vasc Biol 2012;32(7):1552–1162.
- British Society for Heart Failure. Heart failure: a blueprint for change. Available at: https://www.bsh.org.uk/wp-content/uploads/2020/10/Heart-Failure-A-Bluepr.... (Accessed September 2021).
- Solomon SD, et al. Circulation 2007;116(13):1482–1487.
- Okumura N, et al. Circulation 2016;133(23):2254–2262.
- Packer M. Lancet 2020;396(10244):121–128.
- CaReMe UK HF algorithm. Available at: https://www.britishcardiovascularsociety.org/__data/assets/powerpoint_do.... (Accessed September 2021).
- Maddox TM, et al. J Am Coll Cardiol 2021;77:772–810.
- NHS digital. NICE Technology Appraisals in the NHS in England (Innovation Scorecard) To December 2020. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/nic.... (Accessed September 2021).
- McMurray JJ, et al. N Engl J Med 2014;371:993–1004.
- Solomon SD, et al. N Engl J Med 2019;380(6):539–548.
- Novartis Data on File. IPS ENTRESTO 2021.
- ENTRESTO Summary of Product Characteristics. Electronic medicines compendium website, UK. Available at: https://www.medicines.org.uk/emc/product/7751/smpc. (Accessed September 2021).