OBJECTIVES: Sacubitril/valsartan is indicated in adult patients with symptomatic heart failure with reduced ejection fraction. According to its posology, dose should be doubled at 2-4 weeks to the target dose. However, previous real-world studies have reported slow titration schemes. The objective of this analysis was to evaluate sacubitril/valsartan prescription and titration patterns in a real-world setting in Portugal.

METHODS: The PRiMe study is a cross-sectional and multicenter study. Adult patients (≥18 years) or caregivers with a prescription (initial or refill) of sacubitril/valsartan were recruited through Portuguese community pharmacies. A structured questionnaire was applied to collect data directly from the patients or caregivers with support from a trained pharmacist. Additional data were collected through the pharmacy’s software and patient’s echocardiogram report.

RESULTS: As of May 2019, 262 eligible patients (27.6% starting sacubitril/valsartan for the first time) were recruited. The first prescription of sacubitril/valsartan was in 82.3% of the patients filled in by a cardiologist, 9.3% by a general practitioner (GP) and 6.8% by an internist. In the majority of cases (72.9%), sacubitril/valsartan initiation started after a programmed medical appointment and in 25.9% after an emergency/hospitalization episode. Among refills, cardiologists were responsible for 48.1% of refills, GPs for 36.1% and internists for 12.8%. A total of 42.1%, 32.4% and 6.0% of the patients started sacubitril/valsartan 24 mg/26 mg, 49 mg/51 mg and 97 mg/103 mg, twice daily, respectively. After a mean time of 4.9 months (SD=3.9) of sacubitril/valsartan treatment, 31.3% were taking the 24 mg/26 mg dose, 36.5% the 49 mg/51 mg dose and 17.4% the 97 mg/103 mg dose, twice daily. A total of 60.9% patients did not change doses while 31.3% had at least one uptitration.

CONCLUSIONS: In a real-world setting, the uptitration of sacubitril/valsartan is slow, if considered a mean of five months treatment with sacubitril/valsartan.