Discontinuation Rates of Sacubitril/Valsartan at a Large, Community-Based Heart Failure Program: Demographic, Clinical and Payer Origin Associations.

Despite promising results, limited data exist regarding patient characteristics leading to discontinuation of sacubitril/valsartan (S/V) in larger community centers. From July 2016 to March 2018, 193 consecutive patients prescribed S/V were identified by the Slicer/Dicer tool within EPIC EMR platform (Madison, WI). Patients who died prior to agent discontinuation were excluded from the analyses. For nominal data, Chi-squared and Fisher Exact tests were used while one-way ANOVA and linear regression models were used to explore continuous variable associations. A total of 178 eligible patients were identified. Baseline patient characteristics are described in the Table. S/V discontinuation rate was 19.7% (n=35), of which 31.4% were primarily attributed to high cost of the agent (n=11), while symptomatic hypotension was the most commonly reported clinical side-effect (37.1%, n=13). Of the patients who discontinued S/V, 94.2% initiated low dose therapy. Lack of S/V dose reduction (OR: 15.1, p<0.001) and high beta-blocker dose (OR 0.26, p<0.001) were associated with lower rates of discontinuation. Continuous variables associated with S/V discontinuation included higher BUN (24.3 vs. 20.5; p=0.031) and lower number of S/V adjustments (0.5 vs. 2.2; P<0.001), while higher BNP (726.6 vs. 468.6; p=0.054) and lower diastolic blood pressure [(DBP), 71.4 vs. 75.2; p=0.122] trended toward significance. Higher rates of S/V discontinuation were noted compared to clinical trials with high cost as a notable cause. Clinical factors such as higher BUN and BNP and lower DBP may be important adjudicators for appropriate clinical use while patients tolerating higher beta-blocker dose may represent a robust cohort in whom S/V may be better tolerated. Our observed higher rates of intolerance despite conservative low dose S/V initiation may call for more concerted efforts for clinical assessment and non-traditional dose initiation. Confirmation of these observations are warranted with larger registries and prospective studies. [ABSTRACT FROM AUTHOR]