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Introduction: Among patients with HFrEF, treatment with sacubitril/valsartan (SAC/VAL) was shown in PARADIGM-HF to reduce risks of CV death and HF hospitalization compared with enalapril; however, scarce data exist regarding the impact of SAC/VAL on real-world healthcare resource utilization (HCRU) compared to ACEI or ARB. Objective: To compare HCRU among patients with HFrEF treated with SAC/VAL vs. ACEI or ARB. Methods: Using managed care claims data, we identified stable adults with claims-based proxy for HFrEF and ≥1 claim for SAC/VAL (identified first), ACEI or ARB during Oct 2015 to Jun 2016. We required ≥80% proportion of days covered with SAC/VAL or ACE/ARB for first 3 months post index claim. SAC/VAL and ACEI/ARB cohorts were propensity score matched on demographics, baseline characteristics and length of follow-up. Per patient per month (PPPM) HCRU (ambulatory visit, ER visit and hospitalization) and timing of first hospitalization (including estimated failure probabilities) were calculated during a variable follow-up period (3-12 months). HF hospitalization was identified based on first-listed diagnosis code of HF on a hospital facility claim. Robust variance estimation was used to compare PPPM HCRU between matched cohorts and proportional hazards models (no covariate adjustment) were used to evaluate risk of first hospitalization. Results: With mean (SD) follow-up of 185.0 (70.1) days, 279 patients were identified in each of the SAC/VAL cohort and matched ACEI/ARB cohort (mean [SD] age, 67.9 [12.6] years; 73.5% Medicare Advantage enrollee; 26.5% commercial enrollee; 68.1% male; 56.1% diabetes; 46.1% AF; 46.6% hospitalization in 1 year pre index claim). Patients in the SAC/VAL cohort, compared with the ACEI/ARB cohort, experienced lower mean (SD) PPPM all-cause ER visits (0.10 vs. 0.19, p Conclusions: Based on a real-world sample of patients with HFrEF, those initiated with SAC/VAL ≤12 months following US market approval experienced fewer monthly hospitalizations and ER visits compared to ACEI/ARB, and no difference in ambulatory visits. Lower risk of hospitalization after initiating SAC/VAL, rather than using ACEI/ARB, is important since HF hospitalization was previously associated with higher 30-60 day mortality and readmission rate.

Introduction: Heart failure (HF) and reduced ejection fraction (HF r EF) requires timely ACC/AHA guideline recommended treatment (Tx) with multiple pharmacotherapies, including renin-angiotensin system and sympathetic nervous system blockers. The relationship between initial pharmacotherapies (IPT) and treatment modifications ([TM]: add-on or switch to a new class, or discontinuation of IPT) in real world practice is not well understood. Methods: This retrospective cohort study identified Humana Medicare managed care patients (pts) with ≥2 claims for HF from 8/2010-7/2015. The 1st HF claim was the index date. Patients had 1-year (yr) continuous enrollment, no HF diagnosis prior to index, and continuous enrollment 2-yrs post-index or until death. A claims-based algorithm was used to derive HF r EF status. IPT were mono- or combo-use of ACE-inhibitor (ACEI), angiotensin II receptor blocker (ARB), beta blocker (BB), hydralazine-nitrate (HN), and aldosterone antagonist (AA) in 1 yr post-index. No IPT was no drug use, only 1 fill, or st TM in 2 yrs post-index and subsequent therapies were identified. Results: Of 14,359 HF r EF pts, mean (SD) age was 75 (±8) yrs; 45% were female. Post-index, 32% had no IPT after 1 yr, 61% had IPT within 1 month, and 7% initiated IPT after the 1 st month. Of pts with IPT (n=9705), 48% received mono vasodilators (ACEI/ARB or HN), 17% mono BB, 23% vasodilator+BB, and 4% triple therapy [(ACEI/ARB)+BB+(HN or AA)]. Among pts on IPT, 52% had 1 st TM within 2 yrs post-index, with 26% adding a new class, 7% switching to a new class, 9% discontinuing a class of IPT, and 9% discontinuing all IPT. Mean (SD) time from IPT to 1 st TM was 9 (±7) months. For pts with subsequent therapies after 1 st TM, vasodilator+BB was most common (41%), followed by mono vasodilator (15%); then triple therapy (12%). (Table 1) Conclusion: Despite national HF r EF Tx guidelines recommending combo use of vasodilator+BB, nearly 1/3 of pts had no IPT within 1 yr post-index and over ½ received mono Tx as IPT. Of pts on IPT, mean time to 1 st TM was 9 months and few initiated triple therapy. In clinical trials, dual (vasodilator+BB) or triple therapies improved health outcomes. Consequences of HF pharmacotherapy gaps warrant further study.

Background— This study directly compares risk of acute myocardial infarction (AMI), acute heart failure (AHF), or all-cause death among pioglitazone- and rosiglitazone-treated patients in a managed-care population. Methods and Results— Patients ≥18 years of age, newly initiated on rosiglitazone or pioglitazone between January 1, 2001, and December 12, 2005, were included. The date of the first pharmacy claim for rosiglitazone or pioglitazone was defined as index date. Patients were excluded if they had P =0.666) when patients were followed from index date until end of study period, termination of enrollment status, or diagnosis of AMI/AHF/death. Conclusions— In this retrospective cohort study directly comparing rosiglitazone and pioglitazone with a propensity score–matched population that includes mortality data, no significant differences were found in the risk of AMI, AHF or death.