Sacubitril/valsartan (Entresto®) is indicated for the treatment of symptomatic heart failure due to reduced ejection fraction. The NHS Greater Glasgow and Clyde Formulary restricts use to initiation by the specialist heart failure multidisciplinary team in patients with:
- heart failure New York Heart Association (NYHA) class II to IV AND
- left ventricular ejection fraction (LVEF) ≤40% AND
- ongoing symptoms despite optimally tolerated treatment (e.g. beta blocker, ACEI inhibitor (ACEI) or Angiotensin
Receptor Blocker (ARB) and either spironolactone or eplenerone) AND
- plasma B-type natriuretic peptide (BNP) level of at least 150 nanograms/L* or N-terminal pro-BNP level (NT-proBNP) of at least 600 nanograms/L* (or, if they have been hospitalised for heart failure within the previous 12 months, a BNP of at least 100 nanograms/L* or NT-proBNP of at least 400 nanograms/L*)...
* PLEASE NOTE: nanograms/L is equivalent to picograms/mL
Any use of sacubitril/valsartan not covered by this guidance (e.g. unlicensed uses) must be discussed with the multidisciplinary team and the justification explained to the GP on an individual case-by-case basis before initiation, to obtain agreement and ensure governance.
This guidance document is intended primarily for those clinicians and specialist teams involved in the initiation, baseline assessment and subsequent transfer of care to the patient’s GP for ongoing prescribing of sacubitril/valsartan.