title: Early Adoption of Sacubitril/Valsartan for Patients With Heart Failure With Reduced Ejection Fraction: Insights From Get With the Guidelines-Heart Failure (GWTG-HF).
abstract: The aim of this study was to assess the prevalence and variation in angiotensin receptor/neprilysin inhibitor (ARNI) prescription among a real-world population with heart failure with reduced ejection fraction (HFrEF).
  
  
  
  The U.S. Food and Drug Administration approved sacubitril/valsartan for patients with HFrEF in July 2015. Little is known about the early patterns of use of this novel therapy.
  
  
  
  The study included patients discharged alive from hospitals in Get With the Guidelines-Heart Failure (GWTG-HF), a registry of hospitalized patients with heart failure, between July 2015 and June 2016 who had documentation of whether ARNIs were prescribed at discharge. Patient and hospital characteristics were compared among patients with HFrEF (ejection fraction ≤40%) with and without ARNI prescription at discharge, excluding those with documented contraindications to ARNIs. To evaluate hospital variation, hospitals with at least 10 eligible hospitalizations during the study period were assessed.
  
  
  
  Of 21,078 patients hospitalized with HFrEF during the study period, 495 (2.3%) were prescribed ARNIs at discharge. Patients prescribed ARNIs were younger (median age 65 years vs. 70 years; p < 0.001), had lower ejection fractions (median 23% vs. 25%; p < 0.001), and had higher use of aldosterone antagonists (45% vs. 31%; p < 0.001) at discharge. At the 241 participating hospitals with 10 or more eligible admissions, 125 (52%) reported no discharge prescriptions of ARNIs.
  
  
  
  Approximately 2.3% of patients hospitalized for HFrEF in a national registry were prescribed ARNI therapy in the first 12 months following Food and Drug Administration approval. Further study is needed to identify and overcome barriers to implementing new evidence into practice, such as ARNI use among eligible patients with HFrEF.
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Nancy
authors.initials: N
authors.lastname: Luo
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lippmann
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Mi
authors.affiliation: Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Greiner
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: N Chantelle
authors.initials: NC
authors.lastname: Hardy
authors.affiliation: Novartis Pharmaceuticals Corporation, East Hanover, New Jersey.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Turner
authors.affiliation: Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Warren K
authors.initials: WK
authors.lastname: Laskey
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. Electronic address: emily.obrien@duke.edu.
authors.forename: Emily C
authors.initials: EC
authors.lastname: O'Brien
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000613:Aminobutyrates / Q000627:therapeutic use*; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D004338:Drug Combinations; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D015260:Neprilysin / Q000037:antagonists & inhibitors; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D012720:Severity of Illness Index; D013318:Stroke Volume; D013777:Tetrazoles / Q000627:therapeutic use*; D000068756:Valsartan
chemical_list: D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists; D001713:Biphenyl Compounds; D004338:Drug Combinations; D000451:Mineralocorticoid Receptor Antagonists; D013777:Tetrazoles; D000068756:Valsartan; D015260:Neprilysin; C549068:sacubitril and valsartan sodium hydrate drug combination
keywords: early adoption; new therapy; sacubitril/valsartan