COST SAVINGS ASCHIEVED BY REDUCING NEED FOR CARDIAC DEVICES IN PATIENTS WITH SEVERE HEART FAILURE USING LCZ696(SACUBITRIL / VALSARTAN)

Raed Aqel MD.*, Mohanad Saleh MD and Wafa Jubeh R. N.

ABSTRACT

Background: Cardiac resynchronization therapy (CRT) with and without automatic implantable cardioverter-defibrillators (AICDs), AICDs have been recommended as class1A recommendation for a certain subset of patients with Congestive heart failure with reduced ejection fraction (CHFrEF) based on multiple major trials that showed improved mortality and morbidity with these devices, however this comes at great cost which might be unaffordable in some health systems, LCZ696 in previous publication showed improvement in ejection fraction, in this study we for the first time showed some of the cost savings this medication had contributed to by reducing the need for such devices. Materials & Methods: A chart review of patients placed on LCZ696 for clinical purposes over 36 months between 2016 and 2018. All follow-up visits were analyzed. Quality of life-based on New York Heart Association (NYHA) classification was recorded. All hospital admissions, deaths, labs, echocardiograms were recorded. Length of the study was 3months- 36 months (mean of 16 months), all patients whose charts were reviewed, signed an informed consent form allowing for this charts review. Results: 180 charts were reviewed; mean follow-up was 16 months, 14 patients (8%) died during follow-up. 29 patients(16%)stopped the medication, patients receiving LCZ 696 showed 43% improvement in EF and 41% improvement in NYHA class.(125) patients had an ejection fraction of less than 35%on initial presentations, of those (73) patients (64%) improved their ejection fraction to above 35%, and 12 patients (10%) did not have a follow-up echocardiogram, 5 patients (3%) lost follow-up. Conclusion: use of LCZ696 did improve not only quality of life but also ejection fraction resulting in a reduction in the need of devices with subsequent major health cost savings, based on our knowledge this result is the first time to be measured statistically and reported.

Keywords: Sacubitril / valsartan, heart failure, angiotensin receptor-neprilysin inhibitors (ARNIs), NOTE: the guidelines of the STROBE Statement have been adopted in this study.