Despite sacubitril/valsartan being on the market since 2015, clinicians are still determining the best way to initiate therapy to optimize outcomes and minimize potential for side effects. The purpose of this study is to investigate real-world outpatient experience of prescribing sacubitril/valsartan therapy based on appropriate patient selection, dosing conversion, and tolerability. This retrospective cohort study evaluated patients' prescribed sacubitril/valsartan therapy in cardiology clinics associated with an academic institution between February 1, 2016, and August 30, 2018. Patients were excluded if they were less than 18 years of age, enrolled in a clinical trial involving sacubitril/valsartan, or had insufficient data. The primary outcome was to determine how many heart failure patients initiated on sacubitril/valsartan were performed so appropriately based on guideline and package insert recommendations. Select secondary outcomes included rates of adverse events and need for adjustment of concomitant heart failure medications. A total of 250 patients were included in this study. For the primary outcome, 125 patients (50%) were appropriately initiated on sacubitril/valsartan. Those who were inappropriately initiated on the medication experienced more symptoms of hypotension (16% in the appropriate start group vs. 28% in the inappropriate start group; P = 0.022) and required more dose decreases of sacubitril/valsartan (6% in the appropriate start group vs. 13% in the inappropriate start group; P = 0.049). In outpatient clinical practice, almost half of patients initiated on sacubitril/valsartan were performed so outside of guideline recommendations, which was associated with an increased risk of hypotension and dose reductions.

Introduction Standard of care after an acute myocardial infarction (AMI) includes high‐intensity statin therapy to lower the risk of future cardiovascular events. However, the use of high‐intensity statins post‐AMI remains suboptimal, presenting an opportunity for clinical pharmacist services to improve clinical care. Objective To evaluate the impact of a cardiology clinical pharmacist intervention upon the rate of high‐intensity statins issued at hospital discharge after AMI. Methods This was a single‐center, pre‐post study that included patients 18 to 75 years of age who were discharged from one investigative site with a primary diagnosis of AMI (as determined by ICD‐10 codes) between July 2019 to December 2020. The primary outcome was the proportion of patients prescribed high‐intensity statins, defined as atorvastatin 40 to 80 mg or rosuvastatin 20 to 40 mg daily, at discharge pre and postimplementation of a cardiology clinical pharmacist intervention. Patients were stratified into two groups for comparison: pre‐ (07/01/2019‐3/31/2020) and post‐ (04/01/2020‐12/31/2020) intervention, for which the latter included cardiology pharmacist‐driven communication and documentation via the electronic health record. Results A total of 418 patients were included: 223 (53.3%) preintervention and 195 (46.7%) postintervention. The overall cohort was approximately two‐thirds men and 90% Caucasian, with a mean ± SD age of 61.4 ± 9.7 years; the pre and postintervention groups were similar in terms of demographics. The rate of high‐intensity statin prescribing at discharge improved from 83.0% preintervention to 95.4% postintervention (P <.0001). A total of 9.9%, 1.8%, and 5.4% of patients in the preintervention group received moderate‐intensity, low‐intensity, or no statin at discharge, respectively, lowering to 3.1%, 1.0%, and 0.5% postintervention. Conclusion There was a statistically significant increase in the rate of high‐intensity statin prescribing post‐AMI after the implementation of targeted cardiology clinical pharmacist services.