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

Publication ,  Journal Article
DeVore, AD; Hill, CL; Thomas, L; Sharma, PP; Albert, NM; Butler, J; Patterson, JH; Spertus, JA; Williams, FB; Duffy, CI; McCague, K ...
Published in: Circ Heart Fail
September 2018

Background Current guidelines recommend sacubitril/valsartan for patients with heart failure with reduced ejection fraction, but the rate of adoption in the United States has been slow. Methods and Results Using data from CHAMP-HF (Change the Management of Patients With Heart Failure), we described current sacubitril/valsartan use and identified patient, provider, and practice characteristics associated with its use. We considered patients to be on sacubitril/valsartan if they were prescribed it before enrollment or initiated on it at the baseline visit. We excluded patients with a contraindication to sacubitril/valsartan and practices with <10 patients enrolled. Of 4216 patients from 121 sites, 616 (15%) were prescribed sacubitril/valsartan, 2506 (59%) an angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB), and 1094 (26%) neither. Patients prescribed sacubitril/valsartan were younger (63 years versus 66 years ACE inhibitor/ARB versus 69 years neither, P<0.001), less likely to have chronic kidney disease (15% versus 17% ACE inhibitor/ARB versus 30% neither, P<0.001), more likely to have cardiac resynchronization therapy (12% versus 7% ACE inhibitor/ARB versus 7% neither, P<0.001), and had lower ejection fraction (27% versus 30% ACE inhibitor/ARB versus 30% neither, P<0.001). Larger practices, based on number of cardiologists and advanced practice providers, were associated with the highest sacubitril/valsartan use. After multivariable adjustment, the number of advanced practice providers was associated with sacubitril/valsartan use (adjusted odds ratio,1.08; 95% CI, 1.03-1.14). Conclusions Despite current guideline recommendations, adoption of sacubitril/valsartan remains low. Provider and practice characteristics associated with sacubitril/valsartan use were related to general practice size and were not associated with practice characteristics specific for heart failure. Further research is needed to identify strategies for effective quality improvement interventions in chronic heart failure with reduced ejection fraction.

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Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

September 2018

Volume

11

Issue

9

Start / End Page

e005400

Location

United States

Related Subject Headings

  • Valsartan
  • United States
  • Treatment Outcome
  • Time Factors
  • Tetrazoles
  • Specialization
  • Registries
  • Protease Inhibitors
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
 

Citation

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DeVore, A. D., Hill, C. L., Thomas, L., Sharma, P. P., Albert, N. M., Butler, J., … Fonarow, G. C. (2018). Patient, Provider, and Practice Characteristics Associated With Sacubitril/Valsartan Use in the United States. Circ Heart Fail, 11(9), e005400. https://doi.org/10.1161/CIRCHEARTFAILURE.118.005400
DeVore, Adam D., C Larry Hill, Laine Thomas, Puza P. Sharma, Nancy M. Albert, Javed Butler, J Herbert Patterson, et al. “Patient, Provider, and Practice Characteristics Associated With Sacubitril/Valsartan Use in the United States.Circ Heart Fail 11, no. 9 (September 2018): e005400. https://doi.org/10.1161/CIRCHEARTFAILURE.118.005400.
DeVore AD, Hill CL, Thomas L, Sharma PP, Albert NM, Butler J, et al. Patient, Provider, and Practice Characteristics Associated With Sacubitril/Valsartan Use in the United States. Circ Heart Fail. 2018 Sep;11(9):e005400.
DeVore, Adam D., et al. “Patient, Provider, and Practice Characteristics Associated With Sacubitril/Valsartan Use in the United States.Circ Heart Fail, vol. 11, no. 9, Sept. 2018, p. e005400. Pubmed, doi:10.1161/CIRCHEARTFAILURE.118.005400.
DeVore AD, Hill CL, Thomas L, Sharma PP, Albert NM, Butler J, Patterson JH, Spertus JA, Williams FB, Duffy CI, McCague K, Hernandez AF, Fonarow GC. Patient, Provider, and Practice Characteristics Associated With Sacubitril/Valsartan Use in the United States. Circ Heart Fail. 2018 Sep;11(9):e005400.

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

September 2018

Volume

11

Issue

9

Start / End Page

e005400

Location

United States

Related Subject Headings

  • Valsartan
  • United States
  • Treatment Outcome
  • Time Factors
  • Tetrazoles
  • Specialization
  • Registries
  • Protease Inhibitors
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic