OBJECTIVES: PARADIGM-HF, a phase III trial conducted in patients with heart failure and reduced ejection fraction (HFrEF), showed that sacubitril/valsartan, a first-in-class angiotensin receptor-neprilysin inhibitor, provided incremental cardiovascular and overall survival benefit compared to enalapril. This analysis aimed to quantify the number of potential all-cause deaths that could be avoided with optimal usage of sacubitril/valsartan for the treatment of HFrEF in Costa Rica. METHODS: Data from Instituto Nacional de Estadística y Censos was used to identify patients with HFrEF for whom sacubitril/valsartan could be indicated. A literature review was conducted to determine the prevalence of HF, and the proportion of HFrEF patients classified as NYHA Class II-IV, in Latin America. The number needed to treat (NNT) to avoid one all-cause death, standardized to 12 months, was derived from the PARADIGM-HF trial. The potential number of all-cause deaths prevented or postponed with sacubitril/valsartan treatment was estimated using multi-way sensitivity analysis. The main outcome measure was all-cause mortality. RESULTS: The entire 2017 population (≥20 years) was estimated at 3,435,930 and the estimated prevalence of HF was 1.0%. Physician interviews indicated that 60% of patients with chronic HF are diagnosed, yielding approximately 20,616 patients. Half of diagnosed patients had HFrEF, 80% of whom were classified as NYHA Class II-IV, equating to 8,246 patients with HFrEF NYHA II-IV. The absolute reduction in all-cause mortality in PARADIGM-HF was 2.8% over an average follow-up of 27 months with a NNT of 80.3, standardized to 12 months. Thus, optimal usage of sacubitril/valsartan therapy was estimated to prevent 103 deaths each year. CONCLUSIONS: This analysis suggests that a significant number of all-cause deaths could potentially be prevented with optimal implementation of sacubitril/valsartan therapy into routine clinical practice in Costa Rica. However, one limitation of this analysis is the lack of current epidemiology data available specific to HF prevalence in Costa Rica.