Clinical InvestigationEarly impact of guideline publication on angiotensin-receptor neprilysin inhibitor use among patients hospitalized for heart failure
Section snippets
Data sources
We used data from the Get With The Guidelines–Heart Failure (GWTG-HF) registry and the American Hospital Association survey. The details of the GWTG-HF registry have been previously described.9., 10. Briefly, GWTG-HF is a national quality improvement initiative sponsored by the American Heart Association and the American Stroke Association. Trained personnel at participating sites extract information on eligible patients hospitalized for HF and enter information into an online system. Registry
Results
Of 7,200 patients included in the primary analysis population (EF ≤ 40% and no recorded contraindication to ARNI use), 51.9% were discharged in the period directly preceding online publication of the guidelines (2/20/16-5/20/16), and 48.1% were discharged in the period directly after (5/21/16-8/19/16). Baseline characteristics of discharged patients by guideline period are shown in Table I. The distribution of age, race, gender, and insurance status was similar in both periods. Patients in the
Discussion
On May 20, 2016, the ACC/AHA published joint treatment guidelines recommending the use of ARNI for eligible patients with HFrEF. Based on the PARADIGM-HF trial, the ARNI sacubitril/valsartan reduced cardiovascular mortality or HF hospitalization in patients with HFrEF by 20%, and a prior analysis has shown that optimal implementation could have substantial benefits.17., 18. We evaluated the impact of this update on temporal trends in ARNI prescription among patients discharged from hospitals
Conclusions
Use of ARNI at hospitalization discharge is increasing over time but remains low.41 Publication of national guidelines recommending ARNI use in eligible patients did not appear to influence the rate of ARNI uptake among patients with HF discharged from the hospital in the first 3 to 6 months of release. Future studies are needed to identify barriers to guideline adherence in HF and accelerate diffusion of new evidence into practice.
Acknowledgements
The authors would like to thank the GWTG-HF staff and participants for their important contributions to this work.
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Sources of funding: This work was sponsored by Novartis Pharmaceuticals Corporation, East Hanover, NJ. Additionally, the Get With The Guidelines–Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF is sponsored, in part, by Amgen Cardiovascular and has been funded in the past through support from Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable.
Disclosures: E. C. O. receives research support from Janssen, Pfizer, GSK, Novartis, Sanofi, and Bristol Myers Squibb.
L. H. C. receives research support from NIH, PCORI, Novartis, GlaxoSmithKline, Gilead, Boston Scientific, and St Jude.
C. L. C. is an employee of Novartis Pharmaceuticals Corporation and owns stock in Novartis AG.
A. F. H. receives research support from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Luitpold Pharmaceuticals, Merck, and Novartis and honoraria from Bayer, Boston Scientific and Novartis.
G. C. F. receives research funding from NIH and consulting funding from Amgen, Janssen, Medtronic, Novartis, and St Jude Medical.
All other authors have no relevant disclosures.