Sacubitril/Valsartan Initiation and Postdischarge Adherence Among Patients Hospitalized for Heart Failure

Anthony P. Carnicelli; Steven J. Lippmann; Stephen J. Greene; Robert J. Mentz; Melissa A. Greiner; N. Chantelle Hardy; Bradley G. Hammill; Xian Shen; Clyde W. Yancy; Pamela N. Peterson; Larry A. Allen; Gregg C. Fonarow; Emily C. O'BRIEN

doi:10.1016/j.cardfail.2021.03.012

Sacubitril/Valsartan Initiation and Postdischarge Adherence Among Patients Hospitalized for Heart Failure

Anthony P. Carnicelli, Steven J. Lippmann, Stephen J. Greene, Robert J. Mentz, Melissa A. Greiner, N. Chantelle Hardy, Bradley G. Hammill, Xian Shen, Clyde W. Yancy, Pamela N. Peterson, Larry A. Allen, Gregg C. Fonarow, Emily C. O'BRIEN^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

42 Scopus citations

Abstract

Background: We investigated associations between timing of sacubitril/valsartan initiation and postdischarge adherence among patients hospitalized for heart failure with reduced ejection fraction (HFrEF). Clinical trials support initiation of sacubitril/valsartan among patients hospitalized with HFrEF. The association between timing of initiation and postdischarge adherence is unknown. Methods and Results: We analyzed patients hospitalized for HFrEF (EF of ≤40%) within the Get With The Guidelines Heart Failure registry linked with Medicare claims between October 2015 and September 2017 who were eligible for sacubitril/valsartan. Follow-up was through December 2018. Patients were grouped by timing of sacubitril/valsartan initiation. Sacubitril/valsartan adherence at 90 and 365 days after discharge was assessed by calculating proportion of days covered (PDC) using medication fills. Among 4666 patients, 108 (2.3%) were continued on sacubitril/valsartan (on sacubitril/valsartan at admission and discharge), 191 (4.1%) were initiated as inpatients, 130 (2.8%) were initiated at discharge, and 4237 (90.1%) were discharged without sacubitril/valsartan. Median (25th, 75th) proportion of days covered through 90 days among those continued, initiated as inpatients, and initiated at discharge was 0.9 (0.6–0.1), 0.3 (0.0–0.7), and 0.0 (0.0–0.7), respectively (P < .001). Patients discharged without sacubitril/valsartan had very low rates of any sacubitril/valsartan fills within 90 and 365 days of discharge (2.1% and 7.7% of surviving patients, respectively). Conclusions: In 2015–2017 US clinical practice, more than 90% of eligible patients hospitalized for HFrEF were discharged without sacubitril/valsartan. Patients initiated as inpatients had a higher postdischarge proportion of days covered than patients initiated at discharge. Patients discharged without sacubitril/valsartan were unlikely to receive it during follow-up. These findings highlight the importance of initiating sacubitril/valsartan during hospitalization to improve the quality of care.

Original language	English (US)
Pages (from-to)	826-836
Number of pages	11
Journal	Journal of Cardiac Failure
Volume	27
Issue number	8
DOIs	https://doi.org/10.1016/j.cardfail.2021.03.012
State	Published - Aug 2021

Funding

Disclosures, Anthony Carnicelli reports research grant funding from the NIH. Steven Lippmann reports research grant funding from Novartis. Stephen Greene has received a Heart Failure Society of America/ Emergency Medicine Foundation Acute Heart Failure Young Investigator Award funded by Novartis; receives research support from the American Heart Association, Amgen, AstraZeneca, Bristol-Myers Squibb, Merck and Novartis; has served on advisory boards for Amgen and Cytokinetics; and serves as a consultant for Amgen and Merck. Robert Mentz reports research support and honoraria from Abbott, American Regent, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim/Eli Lilly, Boston Scientific, Cytokinetics, Fast BioMedical, Gilead, Innolife, Medtronic, Merck, Novartis, Relypsa, Respicardia, Roche, Sanofi, Vifor, and Windtree Therapeutics. Melissa Greiner reports no relevant disclosures. Chantelle Hardy reports no relevant disclosures. Xian Shen reports employment and stock from Novartis. Larry Allen reports grant funding from AHA, NIH, and PCORI, and reports consulting fees from Abbott, ACI Clinical, Amgen, Boston Scientific, Cytokinetics, and Novartis. Gregg Fonarow reports consulting fees from Abbott, Amgen, AstraZeneca, Bayer, CHF Solutions, Edwards, Janssen, Medtronic, Merck, and Novartis. Emily O'Brien reports grant funding from Bristol Myers Squibb, Novartis, GlaxoSmithKline, and Novo Nordisk. The other authors report no conflicts. Anthony Carnicelli reports research grant funding from the NIH. Steven Lippmann reports research grant funding from Novartis. Stephen Greene has received a Heart Failure Society of America/ Emergency Medicine Foundation Acute Heart Failure Young Investigator Award funded by Novartis; receives research support from the American Heart Association, Amgen, AstraZeneca, Bristol-Myers Squibb, Merck and Novartis; has served on advisory boards for Amgen and Cytokinetics; and serves as a consultant for Amgen and Merck. Robert Mentz reports research support and honoraria from Abbott, American Regent, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim/Eli Lilly, Boston Scientific, Cytokinetics, Fast BioMedical, Gilead, Innolife, Medtronic, Merck, Novartis, Relypsa, Respicardia, Roche, Sanofi, Vifor, and Windtree Therapeutics. Melissa Greiner reports no relevant disclosures. Chantelle Hardy reports no relevant disclosures. Xian Shen reports employment and stock from Novartis. Larry Allen reports grant funding from AHA, NIH, and PCORI, and reports consulting fees from Abbott, ACI Clinical, Amgen, Boston Scientific, Cytokinetics, and Novartis. Gregg Fonarow reports consulting fees from Abbott, Amgen, AstraZeneca, Bayer, CHF Solutions, Edwards, Janssen, Medtronic, Merck, and Novartis. Emily O'Brien reports grant funding from Bristol Myers Squibb, Novartis, GlaxoSmithKline, and Novo Nordisk. The other authors report no conflicts. This work was sponsored by Novartis Pharmaceuticals. The Get With The Guideline®-Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF is sponsored, in part, by Novartis, Boehringer Ingelheim, Eli Lilly Diabetes Alliance, Novo Nordisk, Sanofi, AstraZeneca, and Bayer.

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.cardfail.2021.03.012

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Carnicelli, A. P., Lippmann, S. J., Greene, S. J., Mentz, R. J., Greiner, M. A., Hardy, N. C., Hammill, B. G., Shen, X., Yancy, C. W., Peterson, P. N., Allen, L. A., Fonarow, G. C., & O'BRIEN, E. C. (2021). Sacubitril/Valsartan Initiation and Postdischarge Adherence Among Patients Hospitalized for Heart Failure. Journal of Cardiac Failure, 27(8), 826-836. https://doi.org/10.1016/j.cardfail.2021.03.012

@article{3d592be711244bfea67699309ddf9403,

title = "Sacubitril/Valsartan Initiation and Postdischarge Adherence Among Patients Hospitalized for Heart Failure",

abstract = "Background: We investigated associations between timing of sacubitril/valsartan initiation and postdischarge adherence among patients hospitalized for heart failure with reduced ejection fraction (HFrEF). Clinical trials support initiation of sacubitril/valsartan among patients hospitalized with HFrEF. The association between timing of initiation and postdischarge adherence is unknown. Methods and Results: We analyzed patients hospitalized for HFrEF (EF of ≤40%) within the Get With The Guidelines Heart Failure registry linked with Medicare claims between October 2015 and September 2017 who were eligible for sacubitril/valsartan. Follow-up was through December 2018. Patients were grouped by timing of sacubitril/valsartan initiation. Sacubitril/valsartan adherence at 90 and 365 days after discharge was assessed by calculating proportion of days covered (PDC) using medication fills. Among 4666 patients, 108 (2.3%) were continued on sacubitril/valsartan (on sacubitril/valsartan at admission and discharge), 191 (4.1%) were initiated as inpatients, 130 (2.8%) were initiated at discharge, and 4237 (90.1%) were discharged without sacubitril/valsartan. Median (25th, 75th) proportion of days covered through 90 days among those continued, initiated as inpatients, and initiated at discharge was 0.9 (0.6–0.1), 0.3 (0.0–0.7), and 0.0 (0.0–0.7), respectively (P < .001). Patients discharged without sacubitril/valsartan had very low rates of any sacubitril/valsartan fills within 90 and 365 days of discharge (2.1% and 7.7% of surviving patients, respectively). Conclusions: In 2015–2017 US clinical practice, more than 90% of eligible patients hospitalized for HFrEF were discharged without sacubitril/valsartan. Patients initiated as inpatients had a higher postdischarge proportion of days covered than patients initiated at discharge. Patients discharged without sacubitril/valsartan were unlikely to receive it during follow-up. These findings highlight the importance of initiating sacubitril/valsartan during hospitalization to improve the quality of care.",

author = "Carnicelli, {Anthony P.} and Lippmann, {Steven J.} and Greene, {Stephen J.} and Mentz, {Robert J.} and Greiner, {Melissa A.} and Hardy, {N. Chantelle} and Hammill, {Bradley G.} and Xian Shen and Yancy, {Clyde W.} and Peterson, {Pamela N.} and Allen, {Larry A.} and Fonarow, {Gregg C.} and O'BRIEN, {Emily C.}",

note = "Publisher Copyright: {\textcopyright} 2021 Elsevier Inc.",

year = "2021",

month = aug,

doi = "10.1016/j.cardfail.2021.03.012",

language = "English (US)",

volume = "27",

pages = "826--836",

journal = "Journal of Cardiac Failure",

issn = "1071-9164",

publisher = "Elsevier B.V.",

number = "8",

}

Carnicelli, AP, Lippmann, SJ, Greene, SJ, Mentz, RJ, Greiner, MA, Hardy, NC, Hammill, BG, Shen, X, Yancy, CW, Peterson, PN, Allen, LA, Fonarow, GC & O'BRIEN, EC 2021, 'Sacubitril/Valsartan Initiation and Postdischarge Adherence Among Patients Hospitalized for Heart Failure', Journal of Cardiac Failure, vol. 27, no. 8, pp. 826-836. https://doi.org/10.1016/j.cardfail.2021.03.012

TY - JOUR

T1 - Sacubitril/Valsartan Initiation and Postdischarge Adherence Among Patients Hospitalized for Heart Failure

AU - Carnicelli, Anthony P.

AU - Lippmann, Steven J.

AU - Greene, Stephen J.

AU - Mentz, Robert J.

AU - Greiner, Melissa A.

AU - Hardy, N. Chantelle

AU - Hammill, Bradley G.

AU - Shen, Xian

AU - Yancy, Clyde W.

AU - Peterson, Pamela N.

AU - Allen, Larry A.

AU - Fonarow, Gregg C.

AU - O'BRIEN, Emily C.

PY - 2021/8

Y1 - 2021/8

N2 - Background: We investigated associations between timing of sacubitril/valsartan initiation and postdischarge adherence among patients hospitalized for heart failure with reduced ejection fraction (HFrEF). Clinical trials support initiation of sacubitril/valsartan among patients hospitalized with HFrEF. The association between timing of initiation and postdischarge adherence is unknown. Methods and Results: We analyzed patients hospitalized for HFrEF (EF of ≤40%) within the Get With The Guidelines Heart Failure registry linked with Medicare claims between October 2015 and September 2017 who were eligible for sacubitril/valsartan. Follow-up was through December 2018. Patients were grouped by timing of sacubitril/valsartan initiation. Sacubitril/valsartan adherence at 90 and 365 days after discharge was assessed by calculating proportion of days covered (PDC) using medication fills. Among 4666 patients, 108 (2.3%) were continued on sacubitril/valsartan (on sacubitril/valsartan at admission and discharge), 191 (4.1%) were initiated as inpatients, 130 (2.8%) were initiated at discharge, and 4237 (90.1%) were discharged without sacubitril/valsartan. Median (25th, 75th) proportion of days covered through 90 days among those continued, initiated as inpatients, and initiated at discharge was 0.9 (0.6–0.1), 0.3 (0.0–0.7), and 0.0 (0.0–0.7), respectively (P < .001). Patients discharged without sacubitril/valsartan had very low rates of any sacubitril/valsartan fills within 90 and 365 days of discharge (2.1% and 7.7% of surviving patients, respectively). Conclusions: In 2015–2017 US clinical practice, more than 90% of eligible patients hospitalized for HFrEF were discharged without sacubitril/valsartan. Patients initiated as inpatients had a higher postdischarge proportion of days covered than patients initiated at discharge. Patients discharged without sacubitril/valsartan were unlikely to receive it during follow-up. These findings highlight the importance of initiating sacubitril/valsartan during hospitalization to improve the quality of care.

AB - Background: We investigated associations between timing of sacubitril/valsartan initiation and postdischarge adherence among patients hospitalized for heart failure with reduced ejection fraction (HFrEF). Clinical trials support initiation of sacubitril/valsartan among patients hospitalized with HFrEF. The association between timing of initiation and postdischarge adherence is unknown. Methods and Results: We analyzed patients hospitalized for HFrEF (EF of ≤40%) within the Get With The Guidelines Heart Failure registry linked with Medicare claims between October 2015 and September 2017 who were eligible for sacubitril/valsartan. Follow-up was through December 2018. Patients were grouped by timing of sacubitril/valsartan initiation. Sacubitril/valsartan adherence at 90 and 365 days after discharge was assessed by calculating proportion of days covered (PDC) using medication fills. Among 4666 patients, 108 (2.3%) were continued on sacubitril/valsartan (on sacubitril/valsartan at admission and discharge), 191 (4.1%) were initiated as inpatients, 130 (2.8%) were initiated at discharge, and 4237 (90.1%) were discharged without sacubitril/valsartan. Median (25th, 75th) proportion of days covered through 90 days among those continued, initiated as inpatients, and initiated at discharge was 0.9 (0.6–0.1), 0.3 (0.0–0.7), and 0.0 (0.0–0.7), respectively (P < .001). Patients discharged without sacubitril/valsartan had very low rates of any sacubitril/valsartan fills within 90 and 365 days of discharge (2.1% and 7.7% of surviving patients, respectively). Conclusions: In 2015–2017 US clinical practice, more than 90% of eligible patients hospitalized for HFrEF were discharged without sacubitril/valsartan. Patients initiated as inpatients had a higher postdischarge proportion of days covered than patients initiated at discharge. Patients discharged without sacubitril/valsartan were unlikely to receive it during follow-up. These findings highlight the importance of initiating sacubitril/valsartan during hospitalization to improve the quality of care.

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U2 - 10.1016/j.cardfail.2021.03.012

DO - 10.1016/j.cardfail.2021.03.012

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AN - SCOPUS:85111939318

SN - 1071-9164

VL - 27

SP - 826

EP - 836

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

IS - 8

ER -

Sacubitril/Valsartan Initiation and Postdischarge Adherence Among Patients Hospitalized for Heart Failure

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