Sacubitril/Valsartan Use in Heart Failure reduced Ejection Fraction: Assessing Real-World Practice Outcomes in Heart Failure

OBJECTIVES

To describe clinical outcomes of patients with heart failure with reduced ejection fraction (HFrEF) receiving sacubitril/valsartan in a real-world setting.

MATERIALS AND METHODS

This single-centre, retrospective, non-interventional study was conducted at Hospital Sultan Ismail. Data were collected from 1 January 2023 to 30 June 2025. Adult patients with HFrEF treated with sacubitril/valsartan were included. Exclusion criteria were age <18 years, pregnancy, or heart failure due to pericardial or congenital heart disease. Continuous variables were expressed as mean±SD and categorical variables as number (%). Paired t-test and repeated measures analyses compared outcomes at baseline, 6 months, and 12 months, with p<0.05 considered significant.

RESULTS

A total of 42 patients were included (mean age 60.9±14.1 years; 76.2% male). Comorbidities included hypertension (83.3%), diabetes (54.8%), and coronary artery disease (50%). Left ventricular ejection fraction improved significantly at 6 and 12 months (27.5±8.8% vs 29.8±8.7% vs 31.6±9.4%; p<0.05). NYHA class improved at 6 months (p=0.02) but not at 12 months. Systolic blood pressure decreased at 12 months (p=0.039). Heart failure hospitalisations were reduced (81% vs 40.6% vs 43.8%). All-cause mortality reached 18.8% at 12 months. Adverse events were infrequent.

CONCLUSION

In this real-world HFrEF cohort, sacubitril/valsartan improved cardiac function and reduced heart failure hospitalisations, with a favorable safety profile. These clinical benefits suggest that expanding access beyond current hospital quotas could improve patient outcomes and potentially reduce healthcare costs, supporting broader use in routine practice.