Sacubitril/Valsartan Initiation Among Veterans Who Are Renin‐Angiotensin‐Aldosterone System Inhibitor Naïve With Heart Failure and Reduced Ejection Fraction

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Engels N. Obi¹  James C. Fang¹  Emily B. Levitan²  Jordan B. King³  John A. Dodson⁴  Adam P. Bress⁵  Michelle E. Choi⁶  Patricia A. Russo⁶  Orly Vardeny⁷  Patrick R. Alba⁸  Olga V. Patterson⁸  April F. Mohanty⁸  Jennifer S. Herrick⁸  Tao He⁸  James Cook⁸ 

[1] Outcomes Research Novartis Pharmaceuticals CorporationEast Hanover NJ;Department of Epidemiology University of Alabama at Birmingham School of Public Health Birmingham AL;Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT;Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY;Now with Sanofi Bridgewater NJ;;US Health Economics &University of Minnesota Medical School Minneapolis MN;Veterans Affairs Salt Lake City Health Care System Salt Lake City UT;

关键词: angiotensin receptor neprilysin inhibitor;    heart failure;    medication;    reduced ejection fraction;    titration;   

DOI  :  10.1161/JAHA.120.020474

来源: DOAJ

【 摘 要 】

Background Sacubitril/valsartan, a first‐in‐class angiotensin receptor neprilysin inhibitor, received US Food and Drug Administration approval in 2015 for heart failure with reduced ejection fraction (HFrEF). Our objective was to describe the sacubitril/valsartan initiation rate, associated characteristics, and 6‐month follow‐up dosing among veterans with HFrEF who are renin‐angiotensin‐aldosterone system inhibitor (RAASi) naïve. Methods and Results Retrospective cohort study of veterans with HFrEF who are RAASi naïve defined as left ventricular ejection fraction (LVEF) ≤40%; ≥1 in/outpatient heart failure visit, first RAASi (sacubitril/valsartan, angiotensin‐converting enzyme inhibitor [ACEI]), or angiotensin‐II receptor blocker [ARB]) fill from July 2015 to June 2019. Characteristics associated with sacubitril/valsartan initiation were identified using Poisson regression models. From July 2015 to June 2019, we identified 3458 sacubitril/valsartan and 29 367 ACEI or ARB initiators among veterans with HFrEF who are RAASi naïve. Sacubitril/valsartan initiation increased from 0% to 26.5%. Sacubitril/valsartan (versus ACEI or ARB) initiators were less likely to have histories of stroke, myocardial infarction, or hypertension and more likely to be older and have diabetes mellitus and lower LVEF. At 6‐month follow‐up, the prevalence of ≥50% target daily dose for sacubitril/valsartan, ACEI, and ARB initiators was 23.5%, 43.2%, and 47.1%, respectively. Conclusions Sacubitril/valsartan initiation for HFrEF in the Veterans Administration increased in the 4 years immediately following Food and Drug Administration approval. Sacubitril/valsartan (versus ACEI or ARB) initiators had fewer baseline cardiovascular comorbidities and the lowest proportion on ≥50% target daily dose at 6‐month follow‐up. Identifying the reasons for lower follow‐up dosing of sacubitril/valsartan could support guideline recommendations and quality improvement strategies for patients with HFrEF.

【 授权许可】

Unknown