Characteristics and healthcare utilization among veterans treated for heart failure with reduced ejection fraction who switched to sacubitril/valsartan

April F. Mohanty, Emily B. Levitan, John A. Dodson, Orly Vardeny, Jordan B. King, Joanne Lafleur, Tao He, Olga V. Patterson, Patrick R. Alba, Patricia A. Russo, Michelle E. Choi, Adam P. Bress

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4 Scopus citations


Background: US guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF), who tolerate an ACEI (angiotensin-converting enzyme inhibitor) or ARB (angiotensin II receptor blocker), be switched to sacubitril/valsartan to reduce morbidity and mortality. We compared characteristics and healthcare utilization between Veterans with HFrEF who were switched to sacubitril/valsartan versus maintained on an ACEI or ARB. Methods: retrospective cohort study of treated HFrEF (July 2015-June 2017) using Veterans Affairs data. The index date was the first fill for sacubitril/valsartan and if none, for an ACEI or ARB. Treated HFrEF was defined by (1) left ventricular ejection fraction ≤40%, (2) ≥1 in/outpatient HF encounter, and (3) ≥1 ACEI or ARB fill, all within 1-year preindex. Poisson regression models were used to compare baseline characteristics and 1:1 propensity score-matched adjusted 4-month follow-up healthcare utilization between sacubitril/valsartan switchers and ACEI or ARB maintainers. Results: Switchers (1612; 4.2%) were less likely than maintainers (37 065; 95.8%) to have a history of myocardial infarction or hypertension, and more likely to be black, have a lower left ventricular ejection fraction, and higher preindex healthcare utilization. Switchers were less likely to experience follow-up all-cause hospitalizations (11.2% versus 14.0%; risk ratio 0.80 [95% CI, 0.65-0.98], P value 0.035). Conclusions: Few Veterans with treated HFrEF were switched to sacubitril/valsartan within the first 2 years of Food and Drug Administration approval. Sacubitril/valsartan use was associated with a lower risk for all-cause hospitalizations at 4 months follow-up. Reasons for lack of guideline-recommended sacubitril/valsartan initiation warrant investigation and may reveal opportunities for HFrEF care optimization.

Original languageEnglish (US)
Article numbere005691
JournalCirculation: Heart Failure
Issue number11
StatePublished - Nov 1 2019

Bibliographical note

Funding Information:
We disclose that our Novartis collaborators were involved in the study design, preparation, review, and final approval of the current study. Drs Vardeny and Bress received research support from Novartis. Dr Bress also reported receiving grants from Amarin and Gilead Sciences outside the submitted work. Dr LaFleur received support from Gilead Sciences outside the submitted work. Dr Russo and was an employee of Novartis during the conduct of this study. Dr Choi was an employee of the University of Maryland Baltimore and provided services to Novar-tis, and is currently employed at AbbVie, Inc. Dr Levitan received consulting fees for this work, receives research funding from Amgen, and has served on Amgen advisory boards. Dr King and Mr He received research support to their institution from Novartis. Dr Patterson and Mr Alba have received research grants from the following for-profit organizations through the University of Utah or Western Institute for Biomedical Research: Anolinx LLC, AstraZeneca Pharmaceuticals LP, Genentech Inc., Genomic Health, Inc., Gilead Sciences Inc., Janssen Pharmaceuticals, Inc., Novartis International AG, and PAREXEL International Corporation. Dr. Dodson has no relevant disclosures to declare.

Funding Information:
The present study was funded by an industry-academic collaboration between Novartis and the University of Utah.

Publisher Copyright:
© 2019 American Heart Association, Inc.


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