Author + information
- Received December 9, 2016
- Revision received December 19, 2016
- Accepted December 28, 2016
- Published online March 27, 2017.
- Nancy Luo, MDa,b,
- Gregg C. Fonarow, MDc,
- Steven J. Lippmann, PhDb,
- Xiaojuan Mi, PhDb,
- Paul A. Heidenreich, MD, MSd,
- Clyde W. Yancy, MDe,
- Melissa A. Greiner, MSb,
- Bradley G. Hammill, DrPHa,b,
- N. Chantelle Hardy, MPHb,
- Stuart J. Turner, BPharm, MPHf,
- Warren K. Laskey, MD, MPHg,
- Lesley H. Curtis, PhDa,b,
- Adrian F. Hernandez, MD, MHSa,b,
- Robert J. Mentz, MDa,b and
- Emily C. O’Brien, PhDa,b,∗ ()
- aDepartment of Medicine, Duke University School of Medicine, Durham, North Carolina
- bDuke Clinical Research Institute, Durham, North Carolina
- cAhmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, California
- dDepartment of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- eDivision of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- fNovartis Pharmaceuticals Corporation, East Hanover, New Jersey
- gDivision of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
- ↵∗Address for correspondence:
Dr. Emily C. O’Brien, Duke Clinical Research Institute, 2400 Pratt Street, Room 0311 Terrace Level, Durham, North Carolina 27705.
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.
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.
- Received December 9, 2016.
- Revision received December 19, 2016.
- Accepted December 28, 2016.
- 2017 American College of Cardiology Foundation