{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:14:13Z","timestamp":1792113253964,"version":"4.4.0"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T00:00:00Z","timestamp":1673827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Novartis Farma SpA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Sacubitril\/valsartan reduces heart failure (HF)-related hospitalizations and cardiovascular mortality in PARADIGM-HF and has become a foundational treatment for HF with reduced ejection fraction (HFrEF). However, data of its routine real-world use are limited, and evidence from Italian settings is lacking. The REAL.IT study aimed to characterize the demographics, pharmacotherapy, clinical characteristics and outcomes of sacubitril\/valsartan-treated Italian patients with HFrEF. Electronic medical records of patients initiating sacubitril\/valsartan from October 2016 to June 2019 at nine specialized hospital outpatient HF centers across Italy were reviewed. Overall, 924 adults (mean age 64.5 years, 84.6% male) were included. At baseline, 38.7% had an ischemic HF etiology, 45.9% hypertension, 23.2% atrial fibrillation, 25.4% diabetes mellitus, 26.1% an implantable cardioverter-defibrillator and 31.9% coronary artery bypass grafting. There were no clear patterns of patient selection over time. During follow-up, NYHA class improved in 37.5% of patients after a mean of 5.3 \u00b1 3.8 months; 36.1% and 16.7% of patients were in NYHA class III during characterization and after one year of follow-up, respectively. Left ventricular ejection fraction (LVEF) improved \u22655% in 56.3% of patients at one year; 39.7% had \u226530% reduction of N-terminal pro-B-type natriuretic peptide; 2.2% had hyperkalemia during characterization and 2.6% during follow-up; and 3.8% had hypotension during characterization and 12% during follow-up. A total of 50 (5.8%) of patients had device implantation (ICD\/CRT) during follow-up. HF-related hospitalization was recorded in 19.6% of patients during follow-up; 3.8% of patients died, approximately 1.3% from cardiovascular causes. Our real-world data confirm the favorable effectiveness and tolerability of sacubitril\/valsartan observed in pivotal randomized controlled trials.<\/jats:p>","DOI":"10.3390\/jcm12020699","type":"journal-article","created":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T04:31:32Z","timestamp":1673843492000},"page":"699","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Sacubitril\/Valsartan in Heart Failure with Reduced Ejection Fraction: Real-World Experience from Italy (the REAL.IT Study)"],"prefix":"10.3390","volume":"12","author":[{"given":"Andrea","family":"Di Lenarda","sequence":"first","affiliation":[{"name":"Cardiovascular Center, University Hospital and Health Services of Trieste, 34128 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Di Gesaro","sequence":"additional","affiliation":[{"name":"U.O. Cardiologia IRCCS ISMETT, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2046-8316","authenticated-orcid":false,"given":"Filippo Maria","family":"Sarullo","sequence":"additional","affiliation":[{"name":"U.O.S. Di Riabilitazione Cardiovascolare Ospedale Buccheri La Ferla Fatebenefratelli, 90123 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Miani","sequence":"additional","affiliation":[{"name":"SOC Cardiologia, Dipartimento Cardiotoracico, Azienda Sanitaria Universitaria Friuli Centrale,  Ospedale S. Maria della Misericordia, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3885-4485","authenticated-orcid":false,"given":"Mauro","family":"Driussi","sequence":"additional","affiliation":[{"name":"SOC Cardiologia, Dipartimento Cardiotoracico, Azienda Sanitaria Universitaria Friuli Centrale,  Ospedale S. Maria della Misericordia, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7863-253X","authenticated-orcid":false,"given":"Michele","family":"Correale","sequence":"additional","affiliation":[{"name":"SC Universitaria di Cardiologia AOU \u201cOspedali Riuniti\u201d, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3474-0579","authenticated-orcid":false,"given":"Claudio","family":"Bilato","sequence":"additional","affiliation":[{"name":"U.O.C. Cardiologia Azienda ULSS 8 Berica\u2014Ospedali dell\u2019Ovest Vicentino, 36071 Arzignano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Passantino","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Cardiac Rehabilitation, U.O. Cardiologia ICS Maugeri SpA SB Bari, IRCCS Istituto di Bari, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erberto","family":"Carluccio","sequence":"additional","affiliation":[{"name":"Cardiologia e Fisiopatologia Cardiovascolare, Azienda Ospedaliera Universitaria \u201cSanta Maria della Misericordia\u201d, 06156 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Villani","sequence":"additional","affiliation":[{"name":"U.O. Day Hospital\u2014MAC Cardiologia, Istituto Auxologico Italiano\u2014Ospedale S. Luca, 20149 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"degli Esposti","sequence":"additional","affiliation":[{"name":"CliCon S.r.l. Societ\u00e0 Benefit, 40137 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"d\u2019Agostino","sequence":"additional","affiliation":[{"name":"Cardio-Metabolic Medical Manager, Novartis Farma SpA, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0772-1639","authenticated-orcid":false,"given":"Elena","family":"Peruzzi","sequence":"additional","affiliation":[{"name":"Evidence Generation & Data Analytics Head, Novartis Farma SpA, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Poli","sequence":"additional","affiliation":[{"name":"RWE Data Analyst, Novartis Farma SpA, 20154 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9613-5062","authenticated-orcid":false,"given":"Massimo","family":"Iacoviello","sequence":"additional","affiliation":[{"name":"Surgical and Medical Sciences Department, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,16]]},"reference":[{"key":"ref_1","unstructured":"GBD 2017 Disease Injury and Incidence and Prevalence Collaborators (2018). 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