Patient and Practice Characteristics Associated with Sacubitril/Valsartan Use in the United States

摘要

BackgroundSacubitril/valsartan is recommended by current guidelines for patients with heart failure with reduced ejection fraction (HFrEF), but the rate of adoption in the US has been slow. We examined factors associated with sacubitril/valsartan use in the US. MethodsUsing baseline data from CHAMP-HF, a large US outpatient registry of HFrEF patients, we described current sacubitril/valsartan use and identified patient and practice characteristics associated with its use. Patients with a contraindication to sacubitril/valsartan and practices with <10 patients were excluded. ResultsOf 4216 patients enrolled from 121 US sites between December 2015 and August 2017, 616 (15%) were treated with sacubitril/valsartan, 2506 (59%) with an ACEI/ARB, and 1094 (26%) with neither. Patients treated with sacubitril/valsartan were younger (63 years vs 66 years ACEI/ARB vs 69 years neither, p<.001), less likely to have chronic kidney disease (15% vs 17% ACEI/ARB vs 30% neither, p<.001), more likely to have cardiac resynchronization therapy (12% vs 6.9% ACEI/ARB vs 6.8% neither, p<.001), and had lower left ventricular ejection fraction (27% vs 30% ACEI/ARB vs 30% neither, p<.001). Larger practices, based on number of cardiologists and advanced practice providers, were associated with the highest quartile of sacubitril/valsartan use (). After adjusting for patient and provider characteristics, the number of advanced practice providers was independently associated with sacubitril/valsartan use (adjusted odds ratio 1.08, 95% CI 1.03, 1.14). ConclusionsDespite current guideline recommendations, adoption of sacubitril/valsartan among eligible HFrEF patients remains low and use is associated with patient factors and larger practice size. There remains an opportunity to improve patient outcomes with broader implementation of novel strategies in chronic HFrEF.