Real-world use patterns of angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan) among patients with heart failure within a large integrated health system
Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) that is now preferred in guidelines over angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for patients with heart failure with reduced ejection fraction (HFrEF). However,...
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| Veröffentlicht in: | Journal of managed care & specialty pharmacy 2022-10, Vol.28 (10), p.1173-1179 |
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| creator | Kim, Brendan J Huang, Cheng-Wei Chung, Joanie Neyer, Jonathan R Liang, Brannen Yu, Albert S Kwong, Eric K Park, Joon S Hung, Peggy Sim, John J |
| description | Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) that is now preferred in guidelines over angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for patients with heart failure with reduced ejection fraction (HFrEF). However, it has not been broadly adopted in clinical practice.
To characterize ARNI use within a large diverse real-world population and assess for any racial disparities.
We conducted a cross-sectional study within Kaiser Permanente Southern California. Adult patients with HFrEF who received ARNIs, ACEIs, or ARBs between January 1, 2014, and November 30, 2020, were identified. The prevalence of ARNI use among the cohort and patient characteristics by ARNIs vs ACEIs/ARBs use were described. Multivariable regression was performed to estimate odds ratios and 95% CIs of receiving ARNI by race and ethnicity.
Among 12,250 patients with HFrEF receiving ACEIs, ARBs, or ARNIs, 556 (4.54%) patients received ARNIs. ARNI use among this cohort increased from 0.02% in 2015 to 7.48% in 2020. Patients receiving ARNIs were younger (aged 62 vs 69 years) and had a lower median ejection fraction (27% vs 32%) compared with patients receiving ACEIs/ARBs. They also had higher use of mineralocorticoid antagonists (24.1% vs 19.8%) and automatic implantable cardioverterdefibrillators (17.4% vs 13.3%). There were no significant differences in rate of ARNI use by race and ethnicity.
Within a large diverse integrated health system in Southern California, the rate of ARNI use has risen over time. Patients given ARNIs were younger with fewer comorbidities, while having worse ejection fraction. Racial minorities were no less likely to receive ARNIs compared with White patients.
Dr Huang had stock ownership in Gilead and Pfizer. Dr Liang received support for article processing and medical writing. |
| doi_str_mv | 10.18553/jmcp.2022.28.10.1173 |
| format | Article |
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To characterize ARNI use within a large diverse real-world population and assess for any racial disparities.
We conducted a cross-sectional study within Kaiser Permanente Southern California. Adult patients with HFrEF who received ARNIs, ACEIs, or ARBs between January 1, 2014, and November 30, 2020, were identified. The prevalence of ARNI use among the cohort and patient characteristics by ARNIs vs ACEIs/ARBs use were described. Multivariable regression was performed to estimate odds ratios and 95% CIs of receiving ARNI by race and ethnicity.
Among 12,250 patients with HFrEF receiving ACEIs, ARBs, or ARNIs, 556 (4.54%) patients received ARNIs. ARNI use among this cohort increased from 0.02% in 2015 to 7.48% in 2020. Patients receiving ARNIs were younger (aged 62 vs 69 years) and had a lower median ejection fraction (27% vs 32%) compared with patients receiving ACEIs/ARBs. They also had higher use of mineralocorticoid antagonists (24.1% vs 19.8%) and automatic implantable cardioverterdefibrillators (17.4% vs 13.3%). There were no significant differences in rate of ARNI use by race and ethnicity.
Within a large diverse integrated health system in Southern California, the rate of ARNI use has risen over time. Patients given ARNIs were younger with fewer comorbidities, while having worse ejection fraction. Racial minorities were no less likely to receive ARNIs compared with White patients.
Dr Huang had stock ownership in Gilead and Pfizer. Dr Liang received support for article processing and medical writing.</description><identifier>ISSN: 2376-0540</identifier><identifier>EISSN: 2376-1032</identifier><identifier>DOI: 10.18553/jmcp.2022.28.10.1173</identifier><identifier>PMID: 36125061</identifier><language>eng</language><publisher>United States: Academy of Managed Care Pharmacy</publisher><subject>Adult ; Aminobutyrates ; Angiotensin Receptor Antagonists - therapeutic use ; Angiotensin-Converting Enzyme Inhibitors ; Antihypertensive Agents - pharmacology ; Biphenyl Compounds ; Cross-Sectional Studies ; Delivery of Health Care, Integrated ; Heart Failure - drug therapy ; Humans ; Mineralocorticoid Receptor Antagonists - pharmacology ; Neprilysin - pharmacology ; Receptors, Angiotensin ; Stroke Volume ; Tetrazoles - pharmacology ; Tetrazoles - therapeutic use ; Valsartan - pharmacology ; Valsartan - therapeutic use</subject><ispartof>Journal of managed care & specialty pharmacy, 2022-10, Vol.28 (10), p.1173-1179</ispartof><rights>Copyright © 2022, Academy of Managed Care Pharmacy. All rights reserved. 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c313t-62e8532d46e5f7219c28e9b56cdb81ab66eea213f1188af8aae9e4dff7bf7d993</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10372972/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10372972/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36125061$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Brendan J</creatorcontrib><creatorcontrib>Huang, Cheng-Wei</creatorcontrib><creatorcontrib>Chung, Joanie</creatorcontrib><creatorcontrib>Neyer, Jonathan R</creatorcontrib><creatorcontrib>Liang, Brannen</creatorcontrib><creatorcontrib>Yu, Albert S</creatorcontrib><creatorcontrib>Kwong, Eric K</creatorcontrib><creatorcontrib>Park, Joon S</creatorcontrib><creatorcontrib>Hung, Peggy</creatorcontrib><creatorcontrib>Sim, John J</creatorcontrib><title>Real-world use patterns of angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan) among patients with heart failure within a large integrated health system</title><title>Journal of managed care & specialty pharmacy</title><addtitle>J Manag Care Spec Pharm</addtitle><description>Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) that is now preferred in guidelines over angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for patients with heart failure with reduced ejection fraction (HFrEF). However, it has not been broadly adopted in clinical practice.
To characterize ARNI use within a large diverse real-world population and assess for any racial disparities.
We conducted a cross-sectional study within Kaiser Permanente Southern California. Adult patients with HFrEF who received ARNIs, ACEIs, or ARBs between January 1, 2014, and November 30, 2020, were identified. The prevalence of ARNI use among the cohort and patient characteristics by ARNIs vs ACEIs/ARBs use were described. Multivariable regression was performed to estimate odds ratios and 95% CIs of receiving ARNI by race and ethnicity.
Among 12,250 patients with HFrEF receiving ACEIs, ARBs, or ARNIs, 556 (4.54%) patients received ARNIs. ARNI use among this cohort increased from 0.02% in 2015 to 7.48% in 2020. Patients receiving ARNIs were younger (aged 62 vs 69 years) and had a lower median ejection fraction (27% vs 32%) compared with patients receiving ACEIs/ARBs. They also had higher use of mineralocorticoid antagonists (24.1% vs 19.8%) and automatic implantable cardioverterdefibrillators (17.4% vs 13.3%). There were no significant differences in rate of ARNI use by race and ethnicity.
Within a large diverse integrated health system in Southern California, the rate of ARNI use has risen over time. Patients given ARNIs were younger with fewer comorbidities, while having worse ejection fraction. Racial minorities were no less likely to receive ARNIs compared with White patients.
Dr Huang had stock ownership in Gilead and Pfizer. Dr Liang received support for article processing and medical writing.</description><subject>Adult</subject><subject>Aminobutyrates</subject><subject>Angiotensin Receptor Antagonists - therapeutic use</subject><subject>Angiotensin-Converting Enzyme Inhibitors</subject><subject>Antihypertensive Agents - pharmacology</subject><subject>Biphenyl Compounds</subject><subject>Cross-Sectional Studies</subject><subject>Delivery of Health Care, Integrated</subject><subject>Heart Failure - drug therapy</subject><subject>Humans</subject><subject>Mineralocorticoid Receptor Antagonists - pharmacology</subject><subject>Neprilysin - pharmacology</subject><subject>Receptors, Angiotensin</subject><subject>Stroke Volume</subject><subject>Tetrazoles - pharmacology</subject><subject>Tetrazoles - therapeutic use</subject><subject>Valsartan - pharmacology</subject><subject>Valsartan - therapeutic use</subject><issn>2376-0540</issn><issn>2376-1032</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkd1q3DAQhUVpaUKaR2jRZXvhjX5WsnxVSugfBAIhuRZje-RVsGUjaRP2gfKelTdpaK80nDPzjaRDyEfONtwoJS_up27ZCCbERpjNqvJaviGnQta64kyKty81U1t2Qs5TumeMCam04fI9OZGaC8U0PyVPNwhj9TjHsaf7hHSBnDGGRGdHIQx-zhiSDzRih0ueYxVwiX48rJoPO9_6ItLPCbp9KYtz8QBjgpghfKEwzWFYkR5DTvTR5x3dYTGpAz_uIx6lQgI6QhywEDMOETL2a99Y2tMhZZw-kHeuYPH85Twjdz--317-qq6uf_6-_HZVdZLLXGmBRknRbzUqVwvedMJg0yrd9a3h0GqNCIJLx7kx4AwANrjtnatbV_dNI8_I12fusm8n7Lty7QijLS-eIB7sDN7-7wS_s8P8YMuf16KpRSGoZ0IX55QiutdhzuwxO7tmZ9fsrDBHtWRX5j79u_l16m9S8g8tqZ2Q</recordid><startdate>202210</startdate><enddate>202210</enddate><creator>Kim, Brendan J</creator><creator>Huang, Cheng-Wei</creator><creator>Chung, Joanie</creator><creator>Neyer, Jonathan R</creator><creator>Liang, Brannen</creator><creator>Yu, Albert S</creator><creator>Kwong, Eric K</creator><creator>Park, Joon S</creator><creator>Hung, Peggy</creator><creator>Sim, John J</creator><general>Academy of Managed Care Pharmacy</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>202210</creationdate><title>Real-world use patterns of angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan) among patients with heart failure within a large integrated health system</title><author>Kim, Brendan J ; Huang, Cheng-Wei ; Chung, Joanie ; Neyer, Jonathan R ; Liang, Brannen ; Yu, Albert S ; Kwong, Eric K ; Park, Joon S ; Hung, Peggy ; Sim, John J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c313t-62e8532d46e5f7219c28e9b56cdb81ab66eea213f1188af8aae9e4dff7bf7d993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Aminobutyrates</topic><topic>Angiotensin Receptor Antagonists - therapeutic use</topic><topic>Angiotensin-Converting Enzyme Inhibitors</topic><topic>Antihypertensive Agents - pharmacology</topic><topic>Biphenyl Compounds</topic><topic>Cross-Sectional Studies</topic><topic>Delivery of Health Care, Integrated</topic><topic>Heart Failure - drug therapy</topic><topic>Humans</topic><topic>Mineralocorticoid Receptor Antagonists - pharmacology</topic><topic>Neprilysin - pharmacology</topic><topic>Receptors, Angiotensin</topic><topic>Stroke Volume</topic><topic>Tetrazoles - pharmacology</topic><topic>Tetrazoles - therapeutic use</topic><topic>Valsartan - pharmacology</topic><topic>Valsartan - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Brendan J</creatorcontrib><creatorcontrib>Huang, Cheng-Wei</creatorcontrib><creatorcontrib>Chung, Joanie</creatorcontrib><creatorcontrib>Neyer, Jonathan R</creatorcontrib><creatorcontrib>Liang, Brannen</creatorcontrib><creatorcontrib>Yu, Albert S</creatorcontrib><creatorcontrib>Kwong, Eric K</creatorcontrib><creatorcontrib>Park, Joon S</creatorcontrib><creatorcontrib>Hung, Peggy</creatorcontrib><creatorcontrib>Sim, John J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of managed care & specialty pharmacy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Brendan J</au><au>Huang, Cheng-Wei</au><au>Chung, Joanie</au><au>Neyer, Jonathan R</au><au>Liang, Brannen</au><au>Yu, Albert S</au><au>Kwong, Eric K</au><au>Park, Joon S</au><au>Hung, Peggy</au><au>Sim, John J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Real-world use patterns of angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan) among patients with heart failure within a large integrated health system</atitle><jtitle>Journal of managed care & specialty pharmacy</jtitle><addtitle>J Manag Care Spec Pharm</addtitle><date>2022-10</date><risdate>2022</risdate><volume>28</volume><issue>10</issue><spage>1173</spage><epage>1179</epage><pages>1173-1179</pages><issn>2376-0540</issn><eissn>2376-1032</eissn><abstract>Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) that is now preferred in guidelines over angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for patients with heart failure with reduced ejection fraction (HFrEF). However, it has not been broadly adopted in clinical practice.
To characterize ARNI use within a large diverse real-world population and assess for any racial disparities.
We conducted a cross-sectional study within Kaiser Permanente Southern California. Adult patients with HFrEF who received ARNIs, ACEIs, or ARBs between January 1, 2014, and November 30, 2020, were identified. The prevalence of ARNI use among the cohort and patient characteristics by ARNIs vs ACEIs/ARBs use were described. Multivariable regression was performed to estimate odds ratios and 95% CIs of receiving ARNI by race and ethnicity.
Among 12,250 patients with HFrEF receiving ACEIs, ARBs, or ARNIs, 556 (4.54%) patients received ARNIs. ARNI use among this cohort increased from 0.02% in 2015 to 7.48% in 2020. Patients receiving ARNIs were younger (aged 62 vs 69 years) and had a lower median ejection fraction (27% vs 32%) compared with patients receiving ACEIs/ARBs. They also had higher use of mineralocorticoid antagonists (24.1% vs 19.8%) and automatic implantable cardioverterdefibrillators (17.4% vs 13.3%). There were no significant differences in rate of ARNI use by race and ethnicity.
Within a large diverse integrated health system in Southern California, the rate of ARNI use has risen over time. Patients given ARNIs were younger with fewer comorbidities, while having worse ejection fraction. Racial minorities were no less likely to receive ARNIs compared with White patients.
Dr Huang had stock ownership in Gilead and Pfizer. Dr Liang received support for article processing and medical writing.</abstract><cop>United States</cop><pub>Academy of Managed Care Pharmacy</pub><pmid>36125061</pmid><doi>10.18553/jmcp.2022.28.10.1173</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of managed care & specialty pharmacy, 2022-10, Vol.28 (10), p.1173-1179 |
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| source | MEDLINE; PubMed Central |
| subjects | Adult Aminobutyrates Angiotensin Receptor Antagonists - therapeutic use Angiotensin-Converting Enzyme Inhibitors Antihypertensive Agents - pharmacology Biphenyl Compounds Cross-Sectional Studies Delivery of Health Care, Integrated Heart Failure - drug therapy Humans Mineralocorticoid Receptor Antagonists - pharmacology Neprilysin - pharmacology Receptors, Angiotensin Stroke Volume Tetrazoles - pharmacology Tetrazoles - therapeutic use Valsartan - pharmacology Valsartan - therapeutic use |
| title | Real-world use patterns of angiotensin receptor-neprilysin inhibitor (sacubitril/valsartan) among patients with heart failure within a large integrated health system |
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