Adoption of Sacubitril/Valsartan for the Management of Patients With Heart Failure

Sangaralingham, Lindsey R.; Sangaralingham, S. Jeson; Shah, Nilay D.; Yao, Xiaoxi; Dunlay, Shannon M.

doi:10.1161/circheartfailure.117.004302

Cited by 75 publications

(68 citation statements)

References 30 publications

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“…Similar to the results of prior studies that found low adoption of sacubitril/valsartan treatment in the United States, we found that only 34 patients with HFrEF at VAGLAHS had an active prescription as of November 1, 2017 . Despite our findings of underuse of sacubitril/valsartan in eligible patients, the proportions of patients taking an ACEi/ARB, β‐blocker, or mineralocorticoid antagonist medications suggest that patients at VAGLAHS are managed according to evidence‐based guidelines.…”

Section: Discussionsupporting

confidence: 84%

“…12 Similar to the results of prior studies that found low adoption of sacubitril/valsartan treatment in the United States, we found that only 34 patients with HFrEF at VAGLAHS had an active prescription as of November 1, 2017. [7][8][9] Despite our findings of underuse of sacubitril/ valsartan in eligible patients, the proportions of patients taking an ACEi/ARB, b-blocker, or mineralocorticoid antagonist medications suggest that patients at VAGLAHS are managed according to evidence-based guidelines. We found that 50.6% of patients were taking a mineralocorticoid antagonist, which is even higher than the 33% of patients prescribed this class of medications in the Change the Management of Patients with Heart Failure (CHAMP-HF) registry.…”

Section: Discussionmentioning

confidence: 64%

“…Although evidence and guidelines support the use of an ARNI for further mortality reduction, it remains an underprescribed medication . A claims‐based cohort study of privately insured and Medicare beneficiaries with HFrEF and a registry study assessing patients with HFrEF discharged after HF hospitalizations have estimated that less than 3% of patients with HF were prescribed sacubitril/valsartan within the first 12–16 months of its approval in the United States . This low rate may be due to issues such as formulary restrictions, prior authorization requirements, concern regarding potential adverse effects, and high cost associated with the medication.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Patients with Heart Failure to Determine Eligibility for Treatment with Sacubitril/Valsartan: Insights from a Veterans Administration Healthcare System

et al. 2019

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Study Objective Despite evidence that supports the use of sacubitril/valsartan – the first angiotensin II receptor blocker–neprilysin inhibitor – for mortality reduction in patients with heart failure (HF), it remains underprescribed. The objective of this study was to evaluate eligibility for initiation of sacubitril/valsartan treatment in patients with HF within the largest Veterans Administration healthcare system in the United States. Design Cross‐sectional study. Setting Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS). Patients A total of 2985 patients with a HF diagnosis who were alive as of November 1, 2017. Measurements and Main Results Eligibility for sacubitril/valsartan initiation was based on inclusion and exclusion criteria from the Prospective Comparison of Angiotensin Receptor–Neprilysin Inhibitor with Angiotensin‐Converting–Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM‐HF) trial and the VA Criteria for Use. The proportion of eligible patients was estimated, and characteristics of eligible patients were compared with those in the PARADIGM‐HF trial. Of the 2985 patients with HF who were alive as of November 1, 2017, 965 (32.3%) had HF with reduced ejection fraction (HFrEF). Of these patients with HFrEF, 263 (27.3%) fulfilled eligibility criteria and were considered candidates for sacubitril/valsartan initiation. Of the 702 patients who did not fulfil eligibility criteria, the most common reasons were New York Heart Association functional class I (35.3%) and B‐type natriuretic peptide level of 100 pg/ml or lower (22.2%). Compared with patients in the PARADIGM‐HF trial, VAGLAHS patients were older (70.4 vs 63.8 yrs) and more likely to be male (98.5% vs 79.0%), and a higher proportion had New York Heart Association functional class III symptoms (35.4% vs 23.1%). Of the 965 patients with HFrEF, 34 (3.5%) had an active sacubitril/valsartan prescription as of November 1, 2017, of whom 27 (79.4%) did not meet criteria. Conclusion Whereas 27% of patients with HFrEF were eligible to initiate sacubitril/valsartan, only 3.5% of these patients were prescribed the medication. Although sacubitril/valsartan reduced morbidity and mortality in clinical trials, it remains underused within this VA healthcare system. This analysis provides important insights into the VA and other healthcare systems regarding the opportunity for optimizing guideline‐directed HF therapy.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

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Evaluation of Patients with Heart Failure to Determine Eligibility for Treatment with Sacubitril/Valsartan: Insights from a Veterans Administration Healthcare System

et al. 2019

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“…[54] Despite this, there has been significant inertia with the uptake of sacubitril/valsartan into clinical practice; in the 18 months following FDA approval, <3% of patients in a USA cohort with HFrEF were prescribed sacubitril/valsartan. [55] Various reasons have been suggested to be contributing to this, including the belief that if patients are stable on an ACE inhibitor (or an ARB) then there is no reason to switch to an ARNI.…”

Section: Implementation Of Sacubitril/valsartan Into Clinical Practicementioning

confidence: 99%

Angiotensin receptor-neprilysin inhibitors: A new paradigm in heart failure with reduced ejection fraction

Docherty

McMurray

2019

International Journal of Cardiology

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Despite significant advances in the last 30 years in reducing morbidity and mortality from heart failure with reduced ejection fraction (HFrEF) with pharmacological and device-based therapies, patients remain at a high risk of adverse cardiovascular outcomes. Sacubitril/valsartan, a first-in-class angiotensin receptor-neprilysin inhibitors (ARNI), has been shown to reduce the risk of cardiovascular death or heart failure hospitalisation and improve symptoms in patients with chronic, ambulatory, symptomatic HFrEF in a large, phase 3, multicentre, international, randomised controlled trial, PARADIGM-HF, when compared to the gold-standard angiotensin converting enzyme inhibitor, enalapril. This article will review the development of sacubitril/valsartan, the evidence for its use and its current and future role in the management of HFrEF.

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“…The recruitment of the study started in November 2016 (which corresponds with the approval of sacubitril/valsartan in Spain), and ended in June 2018 prior to the publication of the PIONEER‐HF trial . The low rates of prescription of this drug may be explained by the generalized slow adoption, which has been extensively reported, and to the fact that recruitment was done during an admission for acute HF. Although diuretics are not considered a disease‐modifying therapy, higher doses in similar scenarios have proven to reduce the number of decompensations .…”

mentioning

confidence: 99%

Is lung ultrasound monitoring really useful for impacting rehospitalization and mortality in worsening heart failure? Reply

Rivas‐Lasarte¹,

Álvarez‐García²,

Mirabet³

et al. 2020

European J of Heart Fail

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Adoption of Sacubitril/Valsartan for the Management of Patients With Heart Failure

Abstract: Adoption of sacubitril/valsartan after Food and Drug Administration approval has been slow and may be associated with the high cost.

Cited by 75 publications

References 30 publications

Evaluation of Patients with Heart Failure to Determine Eligibility for Treatment with Sacubitril/Valsartan: Insights from a Veterans Administration Healthcare System

Evaluation of Patients with Heart Failure to Determine Eligibility for Treatment with Sacubitril/Valsartan: Insights from a Veterans Administration Healthcare System

Angiotensin receptor-neprilysin inhibitors: A new paradigm in heart failure with reduced ejection fraction

Is lung ultrasound monitoring really useful for impacting rehospitalization and mortality in worsening heart failure? Reply

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