Abstract 16697: Early Adoption of Sacubitril/Valsartan for Patients With Heart Failure With Reduced Ejection Fraction: Insights From the American Heart Association’s Get With the Guidelines-Heart Failure Registry
Background: The U.S. Food and Drug Administration (FDA) approved the angiotensin-receptor/neprilysin inhibitor (ARNI) sacubitril/valsartan for patients with heart failure with reduced ejection fraction (HFrEF) in July 2015. There is interest in characterizing early patterns of use of this novel therapy.
Objective: Using data from the AHA’s Get With The Guidelines-Heart Failure (GWTG-HF) Registry, we assessed the prevalence and variation in ARNI prescription among a real-world HF population.
Methods: We included patients discharged alive from hospitals in GWTG-HF between July 2015 and March 2016. We compared patient and hospital characteristics among HFrEF (EF≤40%) patients with and without ARNI prescription at discharge, excluding those missing information on whether ARNI was prescribed. To evaluate hospital variation, we assessed hospitals with at least 10 patients discharged during the study period.
Results: Of 13,831 HFrEF hospitalizations without documented contraindications, 221 (1.6%) were prescribed ARNI. Patients with HFrEF prescribed ARNI were younger (median age 63 vs. 70 years, P<.001), were less likely to have ischemic disease (35% vs. 43%, P=.02) and had less renal dysfunction (14% vs 20%, P=.02) than those not prescribed ARNI. Patients prescribed ARNI had similarly high use of beta-blocker (90% vs 89%, P=.7) but higher use of aldosterone antagonist (42% vs 31%, P=.0004) at discharge compared to non-ARNI patients. At the 232 participating hospitals with 10+ HFrEF patients, 168 (72%) reported no discharge prescriptions of ARNI (Table). Hospitals reporting no discharge prescriptions were not statistically different from those that prescribed ARNI (Table).
Conclusions: Less than 2% of HFrEF patients in a national registry were prescribed ARNI in the first 9 months following FDA approval. Further study is needed to identify and overcome barriers of implementing new evidence into practice, such as ARNI use among eligible HFrEF patients.
Author Disclosures: N. Luo: None. G.C. Fonarow: Consultant/Advisory Board; Modest; Amgen, Janssen. Consultant/Advisory Board; Significant; Novartis. X. Mi: None. P.A. Heidenreich: None. C.W. Yancy: None. M.A. Greiner: None. B.G. Hammill: None. N. Hardy: None. S.J. Turner: Employment; Significant; Novartis. W.K. Laskey: None. L.H. Curtis: None. A.F. Hernandez: None. R.J. Mentz: None. E.C. O’Brien: None.
- © 2016 by American Heart Association, Inc.