Long-term sacubitril/valsartan is well tolerated in dogs with heart failure and myxomatous mitral valve disease and suggests excellent survival benefits

Objective: To determine the safety and survival data for dogs with congestive heart failure (CHF) and myxomatous mitral valve disease (MMVD) treated chronically with sacubitril/valsartan. Methods: A retrospective cohort study was completed by identifying dogs with CHF from MMVD and a prescription for sacubitril/valsartan over a 2.8-year period (from February 2023 to December 2025). Dogs that had surgical intervention, left atrial decompression, or an adverse event that necessitated discontinuation of sacubitril/valsartan therapy were removed from survival analysis. Results: 50 dogs with CHF and MMVD, treated with sacubitril/valsartan (mean ± SD dosage, 18.1 ± 5.4 mg/kg, PO, q 12 h) were identified. Five dogs were removed prior to survival analysis. The median survival time after the first episode of CHF was 577 days (range, 431 to 751) for 45 dogs. The survival time in 28 stage D MMVD-affected dogs, 446.5 days (283; 619), was lower than that of 17 stage C MMVD-affected dogs, who had a median survival time of 1,149 (570; infinity) days. Three dogs (6%) had adverse events, suggesting that adverse events secondary to sacubitril/valsartan were rare in this population. After initiation of sacubitril/valsartan and titration to the target dose, the most common improvements were in energy level and exercise capacity (83% of dogs). Conclusions: Sacubitril/valsartan therapy in dogs appears safe and suggests median survival times that eclipse those of prior canine MMVD stage C or D CHF studies. Clinical Relevance: This study reports a dosing schedule and clinical tolerance of sacubitril/valsartan. It further provides important data for planning future prospective studies.