Elsevier

JACC: Heart Failure

Volume 5, Issue 4, April 2017, Pages 305-309
JACC: Heart Failure

Perspectives
Early Adoption of Sacubitril/Valsartan for Patients With Heart Failure With Reduced Ejection Fraction: Insights From Get With the Guidelines–Heart Failure (GWTG-HF)

https://doi.org/10.1016/j.jchf.2016.12.018Get rights and content
Under an Elsevier user license
open archive

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.

Key Words

early adoption
new therapy
sacubitril/valsartan

Abbreviations and Acronyms

ARNI
angiotensin receptor/neprilysin inhibitor
FDA
U.S. Food and Drug Administration
GWTG-HF
Get With the Guidelines–Heart Failure
HF
heart failure
HFrEF
heart failure with reduced ejection fraction

Cited by (0)

This work was sponsored by Novartis Pharmaceuticals. Additionally, the Get With the Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF is sponsored, in part, by Amgen Cardiovascular and has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. Dr. Fonarow has consulted for Novartis (significant), Amgen (modest), and Janssen (modest). Mr. Turner is an employee of Novartis. Dr. Hernandez has received research support from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Luitpold Pharmaceuticals, Merck, and Novartis; and honoraria from Bayer, Boston Scientific, and Novartis. Dr. Mentz has received research support from the National Institutes of Health (grants U10HL110312 and R01AG045551-01A1), Amgen, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Gilead, Novartis, Otsuka, and ResMed; and honoraria from HeartWare, Janssen, Luitpold Pharmaceuticals, Novartis, ResMed, and Thoratec/St. Jude. Dr. O’Brien has received research support from Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, Janssen Pharmaceuticals, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.