Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Sin HY(1), Ip NS(1), Young WM(1), Chu LM(1), Chu HY(2), Yam PW(2), Sun WY(3)
Affiliation :
(1)Department of Pharmacy, Tuen Mun Hospital, (2)Department of Medicine and Geriatrics, Tuen Mun Hospital, (3)School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong
Introduction :
Heart failure (HF), a growing public health concern, is not only associated with significant morbidity and mortality but also imposes a great financial burden on the healthcare system. HF is associated with frequent readmission and hampers patients’ quality of life. Evolving pharmacotherapy for the management of heart failure aims to reduce mortality, prevent hospitalization, and improve the clinical status of patients.
Objectives :
To establish the clinical effectiveness of sacubitril/valsartan by comparing pre-initiation and post-initiation hospitalization data and left ventricular ejection fraction (LVEF) in the local population
Methodology :
The study included all patients with sacubitril/valsartan initiated from October 1, 2017 to December 31, 2021 in Tuen Mun Hospital, except those who discontinued the medication. A total of 487 patients were included in this retrospective study. A quantitative analysis was conducted to assess the change in hospitalization rates and differences in left ventricular ejection fraction (LVEF). Differences between pre-initiation and post-initiation were evaluated in terms of mean reduction and relative risk reduction (RRR). Subgroup analysis was performed to assess the effects for various baseline characteristics.
Result & Outcome :
The study indicated that the use of sacubitril/valsartan reduced the mean of 1-year all-cause hospitalization events by 0.70; t(486) = 6.826, p <.001. By utilizing the medication, the annual medical expenses can be reduced by $14,700, assuming that each hospitalization carries a cost of $21,000. A 0.80 CV-cause hospitalization reduction was observed in the post-initiation group (M = 0.64, SD = 1.51) compared to the pre-initiation group (M = 1.44, SD = 1.51); t(486) = 10.689, p <.001. 43.5% all-cause hospitalization RRR and 61.3% CV-cause hospitalization RRR were found in the post-initiation group. A 12% improvement in LVEF was observed following drug initiation. Subgroup analysis showed that drug effects were consistent in most of the subgroups, except patients with ischemic cardiomyopathy and the subgroup of patients with LVEF>40% might experience a statistically significant lower LVEF improvement.
Sacubitril/valsartan demonstrated its clinical effectiveness by reducing hospitalizations and improving LVEF. Its effectiveness was consistent across most of the subgroups. This study provides clinical evidence to support the use of sacubitril/valsartan as a special drug in a broader local population beyond current Hospital Authority drug formulary criteria.
