title: Potential Mortality Reduction With Optimal Implementation of Angiotensin Receptor Neprilysin Inhibitor Therapy in Heart Failure.
abstract: Angiotensin receptor neprilysin inhibition (ARNI) therapy provided incremental survival benefit to patients with heart failure and reduced ejection fraction (HFrEF) in clinical trials. To date, estimation of the potential benefits that could be gained from optimal implementation of ARNI therapy at the population level have not been quantified.
  
  
  
  To quantify the projected gains for deaths prevented or postponed with comprehensive implementation of ARNI therapy for patients with HFrEF in the United States.
  
  
  
  Eligibility criteria for ARNI therapy, population-based estimates of patients with HFrEF in the United States, and numbers needed to treat to overt death were obtained from published sources. The potential numbers of deaths prevented or postponed as a result of ARNI were estimated along with multiple-way sensitivity analysis.
  
  
  
  All-cause mortality.
  
  
  
  Of 2 736 000 patients with HFrEF patients in the United States, 2 287 296 (84%) were projected to be candidates for ARNI therapy. Optimal implementation of ARNI therapy was empirically estimated to prevent 28 484 deaths a year (range, 18 230-41 017 deaths per year).
  
  
  
  A substantial number of deaths in the United States could potentially be prevented by optimal implementation of ARNI therapy. These data support implementation of evidence into practice in a timely manner because this may have a material impact on population health among patients with HFrEF.
authors.affiliation: The Ahmanson-UCLA (University of California, Los Angeles) Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles2Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina4Associate Editor, JAMA Cardiology.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: TIMI (Thrombolysis in Myocardial Infarction) Study Group, Cardiovascular Division, Brigham and Women's Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: Northwestern University, Feinberg School of Medicine, Chicago, Illinois7Deputy Editor, JAMA Cardiology.
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
mesh_terms: D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D015260:Neprilysin / Q000627:therapeutic use*; D011945:Receptors, Angiotensin; D013318:Stroke Volume; D013777:Tetrazoles; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D011945:Receptors, Angiotensin; D013777:Tetrazoles; D015260:Neprilysin