PMID- 32616944
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220415
IS  - 1920-2903 (Electronic)
IS  - 0008-4123 (Print)
IS  - 0008-4123 (Linking)
VI  - 73
IP  - 3
DP  - 2020 May-Jun
TI  - Pharmacist- or Nurse Practitioner-Led Assessment and Titration of 
      Sacubitril/Valsartan in a Heart Failure Clinic: A Cohort Study.
PG  - 186-192
AB  - BACKGROUND: Sacubitril/valsartan is a first-in-class angiotensin 
      receptor-neprilysin inhibitor indicated in the management of heart failure with 
      reduced ejection fraction, based on the results of the PARADIGM-HF trial. 
      Practice-based studies are needed to validate its effect in real-world settings. 
      Clinical pharmacists are ideally situated to assess and titrate 
      sacubitril/valsartan. OBJECTIVE: To evaluate the utilization, safety, and 
      tolerability of sacubitril/valsartan in a multidisciplinary heart failure clinic, 
      with assessment and titration by a clinical pharmacist or a nurse practitioner. 
      METHODS: A retrospective cohort study was conducted at a heart failure clinic in 
      Abbotsford, Canada. Included were adult patients with heart failure who were 
      currently or formerly taking sacubitril/valsartan. Data collected for the period 
      October 2015 to February 2019 included patient characteristics, New York Heart 
      Association (NYHA) classification, concurrent medications, sacubitril/valsartan 
      dose, adverse effects, and discontinuation rate. RESULTS: In total, 128 patients 
      were included. Mean age was 70.1 years, 98 (77%) of the patients were men, and 79 
      (62%) had NYHA class 2 heart failure. The clinical pharmacist managed care for 78 
      (61%) of the patients, and the nurse practitioner managed care for 50 (39%). 
      Forty-one (32%) of the patients met modified PARADIGM-HF inclusion criteria. 
      Eighty-five (66%) of the patients achieved the target dose of 
      sacubitril/valsartan, with similar proportions for the clinical pharmacist and 
      nurse practitioner groups, over a mean of 2.2 clinic visits. Patients who 
      achieved the sacubitril/valsartan target dose, relative to those who did not, 
      were significantly younger and had higher mean systolic blood pressure at 
      baseline. Twenty-nine percent of patients (35/119) had an improvement in NYHA 
      classification from before initiation of sacubitril/valsartan to achievement of 
      target or maximally tolerated dose. Eighty-five (66%) of the patients experienced 
      an adverse effect, primarily hypotension, and 12 (9%) required a dose reduction. 
      Only 9 (7%) patients discontinued therapy. CONCLUSIONS: This study demonstrates 
      the real-world safety and tolerability of sacubitril/valsartan in the treatment 
      of heart failure, and reinforces that clinical pharmacists can effectively assess 
      and titrate medications in a multidisciplinary heart failure clinic.
CI  - 2020 Canadian Society of Hospital Pharmacists. All content in the Canadian 
      Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital 
      Pharmacy. In submitting their manuscripts, the authors transfer, assign, and 
      otherwise convey all copyright ownership to CSHP.
FAU - Barry, Arden R
AU  - Barry AR
AD  - , BSc, BSc(Pharm), PharmD, ACPR, is a Clinical Pharmacy and Research Specialist 
      with the Abbotsford Regional Hospital and Cancer Centre, Lower Mainland Pharmacy 
      Services, Abbotsford, British Columbia, and Assistant Professor (Partner) with 
      the Faculty of Pharmaceutical Sciences, The University of British Columbia, 
      Vancouver, British Columbia.
FAU - Lee, Candy
AU  - Lee C
AD  - , BSc(Pharm), ACPR, is Clinical Pharmacist with the Surrey Memorial Hospital, 
      Lower Mainland Pharmacy Services, Surrey, British Columbia.
LA  - eng
PT  - Journal Article
DEP - 20200601
PL  - Canada
TA  - Can J Hosp Pharm
JT  - The Canadian journal of hospital pharmacy
JID - 0215645
PMC - PMC7308157
OTO - NOTNLM
OT  - angiotensin receptor-neprilysin inhibitor
OT  - clinical medicine
OT  - clinical pharmacists
OT  - heart failure
OT  - sacubitril/valsartan
COIS- Competing interests: None declared.
EDAT- 2020/07/04 06:00
MHDA- 2020/07/04 06:01
PMCR- 2020/11/01
CRDT- 2020/07/04 06:00
PHST- 2020/07/04 06:00 [entrez]
PHST- 2020/07/04 06:00 [pubmed]
PHST- 2020/07/04 06:01 [medline]
PHST- 2020/11/01 00:00 [pmc-release]
AID - cjhp-73-186 [pii]
PST - ppublish
SO  - Can J Hosp Pharm. 2020 May-Jun;73(3):186-192. Epub 2020 Jun 1.