Nancy Luo1, Gregg C Fonarow2, Steven J Lippmann3, Xiaojuan Mi3, Paul A Heidenreich4, Clyde W Yancy5, Melissa A Greiner3, Bradley G Hammill1, N Chantelle Hardy3, Stuart J Turner6, Warren K Laskey7, Lesley H Curtis1, Adrian F Hernandez1, Robert J Mentz1, Emily C O'Brien8. 1. Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. 2. Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, California. 3. Duke Clinical Research Institute, Durham, North Carolina. 4. Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California. 5. Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 6. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey. 7. Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico. 8. Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. Electronic address: emily.obrien@duke.edu.
Abstract
OBJECTIVES: The aim of this study was to assess the prevalence and variation in angiotensin receptor/neprilysin inhibitor (ARNI) prescription among a real-world population with heart failure with reduced ejection fraction (HFrEF). BACKGROUND: The U.S. Food and Drug Administration approved sacubitril/valsartan for patients with HFrEF in July 2015. Little is known about the early patterns of use of this novel therapy. METHODS: The study included patients discharged alive from hospitals in Get With the Guidelines-Heart Failure (GWTG-HF), a registry of hospitalized patients with heart failure, between July 2015 and June 2016 who had documentation of whether ARNIs were prescribed at discharge. Patient and hospital characteristics were compared among patients with HFrEF (ejection fraction ≤40%) with and without ARNI prescription at discharge, excluding those with documented contraindications to ARNIs. To evaluate hospital variation, hospitals with at least 10 eligible hospitalizations during the study period were assessed. RESULTS: Of 21,078 patients hospitalized with HFrEF during the study period, 495 (2.3%) were prescribed ARNIs at discharge. Patients prescribed ARNIs were younger (median age 65 years vs. 70 years; p < 0.001), had lower ejection fractions (median 23% vs. 25%; p < 0.001), and had higher use of aldosterone antagonists (45% vs. 31%; p < 0.001) at discharge. At the 241 participating hospitals with 10 or more eligible admissions, 125 (52%) reported no discharge prescriptions of ARNIs. CONCLUSIONS: Approximately 2.3% of patients hospitalized for HFrEF in a national registry were prescribed ARNI therapy in the first 12 months following Food and Drug Administration approval. Further study is needed to identify and overcome barriers to implementing new evidence into practice, such as ARNI use among eligible patients with HFrEF.
OBJECTIVES: The aim of this study was to assess the prevalence and variation in angiotensin receptor/neprilysin inhibitor (ARNI) prescription among a real-world population with heart failure with reduced ejection fraction (HFrEF). BACKGROUND: The U.S. Food and Drug Administration approved sacubitril/valsartan for patients with HFrEF in July 2015. Little is known about the early patterns of use of this novel therapy. METHODS: The study included patients discharged alive from hospitals in Get With the Guidelines-Heart Failure (GWTG-HF), a registry of hospitalized patients with heart failure, between July 2015 and June 2016 who had documentation of whether ARNIs were prescribed at discharge. Patient and hospital characteristics were compared among patients with HFrEF (ejection fraction ≤40%) with and without ARNI prescription at discharge, excluding those with documented contraindications to ARNIs. To evaluate hospital variation, hospitals with at least 10 eligible hospitalizations during the study period were assessed. RESULTS: Of 21,078 patients hospitalized with HFrEF during the study period, 495 (2.3%) were prescribed ARNIs at discharge. Patients prescribed ARNIs were younger (median age 65 years vs. 70 years; p < 0.001), had lower ejection fractions (median 23% vs. 25%; p < 0.001), and had higher use of aldosterone antagonists (45% vs. 31%; p < 0.001) at discharge. At the 241 participating hospitals with 10 or more eligible admissions, 125 (52%) reported no discharge prescriptions of ARNIs. CONCLUSIONS: Approximately 2.3% of patients hospitalized for HFrEF in a national registry were prescribed ARNI therapy in the first 12 months following Food and Drug Administration approval. Further study is needed to identify and overcome barriers to implementing new evidence into practice, such as ARNI use among eligible patients with HFrEF.
Authors: Elles M Screever; Martje H L van der Wal; Dirk J van Veldhuisen; Tiny Jaarsma; Astrid Koops; Kuna S van Dijk; Janke Warink-Riemersma; Jenifer E Coster; B Daan Westenbrink; Peter van der Meer; Rudolf A de Boer; Wouter C Meijers Journal: Clin Res Cardiol Date: 2022-08-17 Impact factor: 6.138
Authors: Marcus Dörr; Uwe Riemer; Michael Christ; Johann Bauersachs; Ralph Bosch; Ulrich Laufs; Anja Neumann; Martin Scherer; Stefan Störk; Rolf Wachter Journal: ESC Heart Fail Date: 2021-05-04
Authors: Alexander T Sandhu; Paul A Heidenreich; John Lin; Justin Parizo; Jay Bhattacharya; Jeremy D Goldhaber-Fiebert Journal: Circ Cardiovasc Qual Outcomes Date: 2022-01-18
Authors: Marat Fudim; Sabina Sayeed; Haolin Xu; Roland A Matsouaka; Paul A Heidenreich; Eric J Velazquez; Clyde W Yancy; Gregg C Fonarow; Adrian F Hernandez; Adam D DeVore Journal: Circ Heart Fail Date: 2020-04-06 Impact factor: 8.790
Authors: Matthew T Mefford; Sandra Y Koyama; Justine De Jesus; Rong Wei; Heidi Fischer; Teresa N Harrison; Pauline Woo; Kristi Reynolds Journal: J Am Heart Assoc Date: 2022-03-24 Impact factor: 6.106