Contributor: Nick Hawkes

Sacubitril/valsartan reduces morbidity and mortality in patients with HFrEF, so why has the adoption of this therapy in the outpatient setting been so slow?

DeVore et al. used data from the CHAMP-HF registry, a 121 site-based registry of outpatient HF management. They examined the use of sacubitril/valsartan over a 2 year period in the enrolled practices.

Patients with HFrEF (EF<40%) treated with sacubitril/valsartan (n=616) were compared to patients prescribed an ACEI/ARB (n=2506) or neither sacubitril/valsartan or an ACEI/ARB (n=1094). Patients taking sacubitril/valsartan were younger (63 vs 66 ACEI/ARB vs 69 neither, p<0.001), less likely to have chronic kidney disease (15% vs 17% ACEI/ARB vs 30% neither, p<0.001), more likely to have cardiac resynchronization therapy (12% vs 7% ACEI/ARB vs 7% neither, p<0.001), with a lower ejection fraction (27% vs 30% ACEI/ARB vs 30% neither, p<0.001). Larger practices, namely those with more cardiologists and advanced practice providers, were associated with higher sacubitril/valsartan use.

Further analysis showed that patients taking sacubitril/valsartan were less likely to be of Hispanic ethnicity, more likely to have private insurance, more likely to have a college degree, less likely to be unemployed, and more likely to be treated with beta-blockers, aldosterone antagonists, and ivabradine. Of note, over the two years of the study, the portion of patients treated with sacubitril/valsartan rose from 9% to 24%.

No study is perfect. CHAMP-HF is composed of voluntary contributing sites and this analysis only includes patients who had data in multiple surveys over time. Additionally, the investigators were not able to analyze costs, access, and formulary issues that may have influenced prescribing.

In a heartbeat… the adoption of sacubitril/valsartan has been slow, but prescribing rates are increasing over time. Interestingly, more advanced practice providers in a practice are associated with higher rates of use– a finding worth exploring further.

Study Link: Patient, Provider, and Practice Characteristics Associated With Sacubitril/Valsartan Use in the United States