Subpar Prescription of Sacubitril/Valsartan Remains a Barrier in Heart Failure Management, With Stephen Greene, MD

Data from a major registry suggests more than 90% of patients with heart failure with reduced ejection were discharged from the hospital without being prescribed sacubitril/valsartan (Entresto) and more than 90% of those patients never filled a prescription in the year following hospitalization.

A recent analysis of data from the Get With The Guidelines-Heart Failure (GWTG-HF) registry is underlining the importance of initiating guideline-directed heart failure therapies at discharge.

Results of the analysis, which included data from more than 4500 patients with heart failure with reduced ejection fraction (HFrEF), suggest less than 10% of eligible patients hospitalized in a 2-year period were prescribed sacubitril/valsartan (Entresto) at discharge.

“When these patients are hospitalized and under close monitoring in the hospital, you have the potential to set the course for their long-term use of medication, not just the short-term,” said study investigator Stephen Greene, MD, assistant professor of medicine at Duke University School of Medicine, in an interview with Practical Cardiology. “While we have seen this pattern in other guideline-directed medical therapies, we had not looked at this for sacubitril/valsartan—one of our newer heart failure therapies.”

With an interest in developing a greater understanding of contemporary trends in prescription of sacubitril/valsartan, Green and a team of colleagues designed the current study as an analysis of Medicare beneficiaries hospitalized from October 2015-September 2017 for HFrEF within the GWTG-HF registry. With follow-up data through December 2018, investigators identified a cohort of 4666 patients from the registry for inclusion in their analysis.

Categorizing patients according to timing of sacubitril/valsartan initiation, patients were divided into 4 groups. The primary outcomes of interest for the investigators’ analyses were the rates sacubitril/valsartan adherence at 90 and 365 days after discharged, which was measured according to the proportion of days covered using medication fills.

Overall, 90.1% (n=4237) of patients were discharged without being prescribed sacubitril/valsartan. Results indicated 4.1% (n=191) were initiated as inpatients, 2.8% (n=130) were initiated at discharge, and 2.3% (n=108) patients were receiving sacubitril/valsartan at admission and discharge. Upon analysis, investigators found surviving patients who were discharged without sacubitril/valsartan had prescription fill rates of 2.1% at 90 days after discharge and 7.7% at 365 days after discharge.

“We need to recognize that, of patients that go home from the hospital for heart failure, 1-in-4 of those patients are either passed away or rehospitalized within 30 days of going home,” Greene added. “We’re lucky to have these therapies at our disposal and these therapies actually have major risk reduction accrue quickly after initiation.”

For more from Greene, check out these clips from his interview with Practical Cardiology.

This study, “Sacubitril/Valsartan Initiation and Postdischarge Adherence Among Patients Hospitalized for Heart Failure,” was published in the Journal of Cardiac Failure.