Early Adoption of Sacubitril/Valsartan for Patients With Heart Failure With Reduced Ejection Fraction Insights From Get With the Guidelines-Heart Failure (GWTG-HF)

被引：111

作者：

Luo, Nancy ^{[1
]}

Fonarow, Gregg C.

Lippmann, Steven J.

Mi, Xiaojuan ^{[2
,5
]}

Heidenreich, Paul A.

Yancy, Clyde W.

Greiner, Melissa A. ^{[3
,4
]}

Hammill, Bradley G. ^{[2
]}

Hardy, N. Chantelle

Turner, Stuart J. ^{[3
,7
]}

Laskey, Warren K. ^{[6
]}

Curtis, Lesley H. ^{[2
,4
]}

Hernandez, Adrian F. ^{[5
,7
]}

Mentz, Robert J. ^{[3
,4
]}

O'Brien, Emily C. ^{[2
]}

机构：

[1] Duke Univ, Sch Med, Dept Med, Durham, NC 27706 USA

[2] Duke Clin Res Inst, 2400 Pratt St,Room 0311 Terrace Level, Durham, NC 27705 USA

[3] Univ Calif Los Angeles, Ahmanson UCLA Cardiomyopathy Ctr, Los Angeles, CA USA

[4] Vet Affairs Palo Alto Hlth Care Syst, Dept Med, Palo Alto, CA USA

[5] Northwestern Univ, Feinberg Sch Med, Div Cardiol, Chicago, IL USA

[6] Novartis Pharmaceut, E Hanover, NJ USA

[7] Univ New Mexico, Div Cardiol, Sch Med, Albuquerque, NM USA

来源：

JACC-HEART FAILURE | 2017年 / 5卷 / 04期

基金：

美国国家卫生研究院;

关键词：

early adoption; new therapy; sacubitril/valsartan;

D O I：

10.1016/j.jchf.2016.12.018

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES 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). BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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 ARM use among eligible patients with HFrEF.(C) 2017 by the American College of Cardiology Foundation.

引用

页码：305 / 309

页数：5