Sacubitril/Valsartan Adherence and Postdischarge Outcomes Among Patients Hospitalized for Heart Failure With Reduced Ejection Fraction

Anthony P. Carnicelli, Zhen Li, Melissa A. Greiner, Steven J. Lippmann, Stephen J. Greene, Robert J. Mentz, N. Chantelle Hardy, Vanessa Blumer, Xian Shen, Clyde W. Yancy, Pamela N. Peterson, Larry A. Allen, Gregg C. Fonarow, Emily C. O'Brien*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objectives: The authors sought to investigate associations between sacubitril/valsartan adherence and clinical outcomes after hospitalization for heart failure with reduced ejection fraction (HFrEF). Background: Sacubitril/valsartan improves outcomes in HFrEF, though the extent to which medication adherence is associated with outcomes in routine care is less well characterized. Methods: The authors analyzed patients aged ≥65 years hospitalized for HFrEF within the Get With the Guidelines–Heart Failure registry linked with Medicare claims between October 2015 and September 2018 who were discharged with sacubitril/valsartan. Sacubitril/valsartan adherence was assessed using medication fills to calculate proportion of days covered (PDC) through 90 days postdischarge. Associations between postdischarge adherence (PDC < or ≥80%) and risk of readmission and death within 1 year were examined by comparing cumulative incidences and adjusted event rates. Results: Among 897 patients prescribed sacubitril/valsartan at discharge, 295 (32.9%) had PDC ≥80% and 602 (67.1%) had PDC <80%. Baseline characteristics were balanced between groups. Compared with patients with PDC <80%, patients with PDC ≥80% had a significantly lower adjusted hazard of all-cause rehospitalization (HR: 0.66 [95% CI: 0.48-0.89]) and death (HR: 0.42 [95% CI: 0.22-0.79]) at 90 days and at 1 year (HR: 0.69 [95% CI: 0.56-0.86] and HR: 0.53 [95% CI: 0.38-0.74], respectively). For every 5 percentage point increase in PDC, patients experienced a significant reduction in rehospitalization (HR: 0.98 [95% CI: 0.97-0.99]) and death (HR: 0.96 [95% CI: 0.94-0.97]) at 1 year. Conclusions: In patients hospitalized for HFrEF and discharged on sacubitril/valsartan, high adherence to sacubitril/valsartan within 90 days after discharge was associated with substantially lower rates of readmission and death. Additional efforts to improve adherence with sacubitril/valsartan and other guideline-directed medical therapies in HFrEF are warranted.

Original languageEnglish (US)
Pages (from-to)876-886
Number of pages11
JournalJACC: Heart Failure
Issue number12
StatePublished - Dec 2021


  • ARNI
  • HFrEF
  • adherence
  • sacubitril/valsartan

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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