Real-World Sacubitril/Valsartan Adoption and Post-Initiation Dose Reassessment and Titration in Heart Failure with Reduced Ejection Fraction: An Explanatory Sequential Mixed-Methods Study from Northern Saudi Arabia

Background/Objectives: Sacubitril/valsartan is a foundational therapy for heart failure with reduced ejection fraction (HFrEF), but real-world implementation extends beyond initiation to laboratory monitoring, follow-up, dose reassessment, and documentation of reasons for sub-target therapy. We evaluated this prescribing pathway in a regional Saudi heart-failure service.