Dose reduction necessary in some HFrEF patients on sacubitril-valsartan

Some patients with heart failure with reduced ejection fraction (HFrEF) need a loop diuretic dose reduction within 2‒3 months following initiation of sacubitril-valsartan, suggests a study.

“Previous literature has suggested a potential diuretic-sparing effect as early as 6 months following sacubitril-valsartan initiation in patients with HFrEF; however, whether this effect manifests earlier after initiation is unclear,” said the researchers, who then set out to assess the acute diuretic-sparing effects of sacubitril-valsartan in a single-centre, retrospective study.

The primary outcome was the percent of patients with an increase, decrease, or no change in loop diuretic total daily dose (TDD), while secondary ones included change in loop diuretic TDD (mg furosemide equivalents) and hospital admissions or emergency department (ED) visits.

A total of 145 patients with a concomitant loop diuretic prescription were included (overall cohort), of which 120 continued sacubitril-valsartan at follow-up of 90 days (on-treatment cohort).

Twenty-four (20 percent) patients in the on-treatment cohort had a reduction in loop diuretic TDD, while 12 (10 percent) had an increase. Median change in loop diuretic TDD did not change from baseline to follow-up (p=0.13). Mean change in nine patients on >80 mg TDD of furosemide at baseline was ‒53 mg (p=0.006).

In addition, hospitalizations (6.2 percent) and ED visits (0.7 percent) for heart failure were rare.

“This diuretic-sparing effect appears larger in those on higher baseline loop diuretic doses, and closer follow up may be warranted for these patients,” the researchers said.