1. Patient, Provider, and Practice Characteristics Associated With Sacubitril/Valsartan Use in the United States.
- Author
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DeVore AD, Hill CL, Thomas L, Sharma PP, Albert NM, Butler J, Patterson JH, Spertus JA, Williams FB, Duffy CI, McCague K, Hernandez AF, and Fonarow GC
- Subjects
- Aged, Aged, 80 and over, Aminobutyrates adverse effects, Angiotensin II Type 1 Receptor Blockers adverse effects, Biphenyl Compounds, Clinical Decision-Making, Drug Combinations, Female, Guideline Adherence trends, Heart Failure diagnosis, Heart Failure epidemiology, Heart Failure physiopathology, Humans, Male, Middle Aged, Neprilysin antagonists & inhibitors, Patient Selection, Practice Guidelines as Topic, Practice Patterns, Physicians' standards, Protease Inhibitors adverse effects, Registries, Tetrazoles adverse effects, Time Factors, Treatment Outcome, United States epidemiology, Valsartan, Ambulatory Care trends, Aminobutyrates therapeutic use, Angiotensin II Type 1 Receptor Blockers therapeutic use, Heart Failure drug therapy, Patients, Practice Patterns, Physicians' trends, Protease Inhibitors therapeutic use, Specialization trends, Tetrazoles therapeutic use
- Abstract
Background Current guidelines recommend sacubitril/valsartan for patients with heart failure with reduced ejection fraction, but the rate of adoption in the United States has been slow. Methods and Results Using data from CHAMP-HF (Change the Management of Patients With Heart Failure), we described current sacubitril/valsartan use and identified patient, provider, and practice characteristics associated with its use. We considered patients to be on sacubitril/valsartan if they were prescribed it before enrollment or initiated on it at the baseline visit. We excluded patients with a contraindication to sacubitril/valsartan and practices with <10 patients enrolled. Of 4216 patients from 121 sites, 616 (15%) were prescribed sacubitril/valsartan, 2506 (59%) an angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB), and 1094 (26%) neither. Patients prescribed sacubitril/valsartan were younger (63 years versus 66 years ACE inhibitor/ARB versus 69 years neither, P<0.001), less likely to have chronic kidney disease (15% versus 17% ACE inhibitor/ARB versus 30% neither, P<0.001), more likely to have cardiac resynchronization therapy (12% versus 7% ACE inhibitor/ARB versus 7% neither, P<0.001), and had lower ejection fraction (27% versus 30% ACE inhibitor/ARB versus 30% neither, P<0.001). Larger practices, based on number of cardiologists and advanced practice providers, were associated with the highest sacubitril/valsartan use. After multivariable adjustment, the number of advanced practice providers was associated with sacubitril/valsartan use (adjusted odds ratio,1.08; 95% CI, 1.03-1.14). Conclusions Despite current guideline recommendations, adoption of sacubitril/valsartan remains low. Provider and practice characteristics associated with sacubitril/valsartan use were related to general practice size and were not associated with practice characteristics specific for heart failure. Further research is needed to identify strategies for effective quality improvement interventions in chronic heart failure with reduced ejection fraction.
- Published
- 2018
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