{"id":"ae5014faccd5","type":"article","url":"https://hartvaat.nl/2026/05/05/off-label-dosering-van-sacubitril-valsartan-wijdverspreid-in-de-praktijk/","title":"Off-label dosering van sacubitril-valsartan wijdverspreid in de praktijk","title_en":"Global trend and predictors of non-labelled sacubitril-valsartan dosing: results from IKNOW-HF survey.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag162","source_url":"https://doi.org/10.1093/eschf/xvag162","authors":["Israa Fadhil Yaseen","Hasan Ali Farhan","Justin Paul Gnanaraj","Hidehira Fukaya","Hawani Sasmaya Prameswari","Clara Saldarriaga","Tuğba Kemaloğlu Öz","Somaya Aref Elhout","Pablo Díez-Villanueva","Maria Rosa Costanzo","Mustafa Toma","Nafisa Omar Elsammani Elsheikh Ibrahim","Zainab Atiyah Dakhil","Nathan Mewton","Wilfried Mullens"],"significance":5,"published":"2026-07-30","source_date":"2026-05-05","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"A global survey of 1,285 clinicians reveals that 86.1% prescribe sacubitril-valsartan at unlabelled doses in heart failure patients, often as a pragmatic strategy for advanced disease. Prescribing patterns vary significantly by region and experience, with HF specialists more likely to deviate from standard dosing while pharmacist involvement shows a trend toward reduced non-labelled use. These findings highlight a substantial gap between guideline recommendations and real-world practice, underscoring the need for targeted education and greater integration of clinical pharmacists to optimize GDMT.","created":"2026-07-22T01:22:50Z","updated":"2026-08-10T10:37:50Z","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":"Een wereldwijde enquête onder 1.285 zorgverleners toont aan dat 86,1% sacubitril-valsartan buiten de geregistreerde doseringen voorschrijft bij hartfalen. Deze off-label dosering komt vaker voor bij hartfalen-specialisten en in landen met een lager inkomen, terwijl meer dan tien jaar ervaring ermee correleert. Het onderzoek benadrukt de kloof tussen richtlijnen en de dagpraktijk en pleit voor betere voorlichting en bredere inzet van klinisch apothekers om de GDMT te optimaliseren.","abstract_original":"BACKGROUND AND AIMS: Optimizing guideline-directed medical therapy (GDMT) remains vital for heart failure (HF) management. However, non-labelled dosing of sacubitril-valsartan is increasingly reported.This global survey characterized real-world sacubitril-valsartan prescribing patterns and evaluated pharmacist involvement in HF teams. METHODS: The validated 26-item IKNOW-HF survey was disseminated globally to clinicians treating patients with HF. Participation was voluntary and anonymous. RESULTS: Out of 1829 responses from 76 countries, 1285 (70.3%) were complete, predominantly from cardiologists 1031 (80.2%). Non-labelled sacubitril-valsartan dosing was reported by 1107 (86.1%) respondents, heavily driven by general cardiologists 326 (90%) and clinicians in the low- and lower-middle-income countries 195 (96%). Predictors of non-labelled dosing included practicing in Asia [odds ratio (OR) 0.347; 95% confidence interval (CI) (0.214-0.563)] and having over 10 years of experience [OR 0.695; 95% CI (0.489-0.990)]. The presence of a cardiology pharmacist trended towards a fewer non-labelled prescriptions [OR 0.542; 95% CI (0.283-1.039), P-value = 0.065], whereas management by HF specialist trended towards increased non-labelled usage [OR 1.443; 95% CI (0.981-2.122), P-value = 0.063]. CONCLUSIONS: The IKNOW-HF survey reveals a substantial variation between guideline-recommended and real-world prescribing practices, with over 80% of responding clinicians utilizing non-labelled dosing. The higher prevalence among HF specialists likely reflects a pragmatic salvage strategy for advanced HF patients intolerant to standard target doses. These findings highlight the need for further education, pragmatic clinical trials evaluating real-world dosing outcomes, and broader integration of specialized pharmacists to optimize GDMT."}