{"id":"cb3d42585b53","type":"article","url":"https://hartvaat.nl/2026/03/03/tien-jaar-real-world-sacubitril-valsartan-mortaliteitsreductie-bevestigd-maar-sl/","title":"Tien jaar real-world sacubitril/valsartan: mortaliteitsreductie bevestigd, maar slechts 15–25% haalt doeldosis","title_en":"","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","answer-hf","sacubitril-valsartan","soul-trial"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag095","source_url":"https://doi.org/10.1093/eschf/xvag095","authors":["Gianluigi Savarese","Christian Basile","Alexandre Mebazaa","Antoni Bayes-Genis","Seok Min Kang","Byung-Su Yoo","Carlos Eid","Biykem Bozkurt","Javed Butler"],"significance":6,"published":"2026-04-20","source_date":"2026-03-03","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/ace-remmers-bij-hartfalen/"],"congress":"","summary_en":"This systematic review of 30 real-world studies confirms sacubitril/valsartan in HFrEF is associated with 10–16% lower cardiovascular mortality, 10–38% fewer HF hospitalisations and 10–25% lower all-cause mortality, along with cardiac reverse remodelling and reduced mitral regurgitation. Hypotension remained the most common adverse event (up to 17.6%). Only 15–25% of patients reach target dose — the true bottleneck is titration discipline rather than drug efficacy.","created":"2026-07-03T10:32:46Z","updated":"2026-07-03T13:31:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze systematische review van 30 real-world studies bevestigt dat sacubitril/valsartan bij HFrEF is geassocieerd met 10–16% lagere cardiovasculaire mortaliteit, 10–38% minder HF-hospitalisaties en 10–25% lagere all-cause mortaliteit. Ook werd reverse remodeling en verbetering van mitralisinsufficiëntie gezien. Hypotensie bleef de meest gemelde bijwerking (tot 17,6%). Slechts 15–25% van de patiënten bereikt de doeldosis — het echte probleem blijft dus optimale titratie in de praktijk, niet de werkzaamheid.","abstract_original":"INTRODUCTION: Sacubitril/valsartan (Sac/Val) represents a cornerstone of heart failure (HF) with reduced ejection fraction (HFrEF) management. This systematic review provides a comprehensive overview of real-world evidence (RWE) regarding the implementation, clinical effectiveness, and safety of Sac/Val in patients with HFrEF. METHODS: A systematic literature search of PubMed was conducted through March 2024 following PRISMA guidelines. RESULTS: The review included 45 manuscripts from 30 different studies, primarily from Europe (44%) and the US (30%). RWE confirmed that Sac/Val was associated with a lower risk of cardiovascular mortality (10%-16%), HF hospitalization (10%-38%), and all-cause mortality (10%-25%). Sac/Val was significantly associated with cardiac reverse remodeling and lower-grade mitral regurgitation. Despite these benefits, implementation gaps persist, with only 15%-25% of patients achieving target doses in clinical practice. The most common reported adverse event with Sac/Val was hypotension (up to 17.6%), though severe hyperkalaemia and renal decline were similar when compared with traditional renin angiotensin system inhibitors. CONCLUSION: Real-world data mirror the efficacy and safety profiles seen in randomized controlled trials, establishing Sac/Val as a cornerstone of HFrEF therapy. However, significant barriers remain, including delayed initiation and suboptimal dose titration. Enhancing clinician and patient awareness is needed to bridge these implementation gaps and fully realize the drug's potential to reduce the global healthcare burden of HF."}