Sacubitril/Valsartan Initiation Among Veterans Who Are Renin-Angiotensin-Aldosterone System Inhibitor Naïve With Heart Failure and Reduced Ejection Fraction.
Sacubitril/Valsartan Initiation Among Veterans Who Are Renin-Angiotensin-Aldosterone System Inhibitor Naïve With Heart Failure and Reduced Ejection Fraction.
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DOI：
10.1161/jaha.120.020474
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发表时间：
2021-10-19
影响因子：
5.4
通讯作者：
Bress AP
中科院分区：
文献类型：
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作者：
Mohanty AF;Levitan EB;King JB;Dodson JA;Vardeny O;Cook J;Herrick JS;He T;Patterson OV;Alba PR;Russo PA;Obi EN;Choi ME;Fang JC;Bress AP
沙库巴曲/缬沙坦是一种一流的血管紧张素受体脑啡肽酶抑制剂，于2015年获得美国食品和药物管理局批准用于射血分数降低的心力衰竭（HFrEF）。我们的目的是描述未接受过肾素-血管紧张素-醛固酮系统抑制剂（RAASi）治疗的HFrEF退伍军人中沙库巴曲/缬沙坦的启动率、相关特征和6个月随访给药。对患有HFrEF的退伍军人进行回顾性队列研究，这些退伍军人未经RAASi治疗，定义为左心室射血分数（LVEF）≤40%; 2015年7月至2019年6月期间，≥1次住院/门诊心力衰竭就诊，首次RAASi（沙库巴曲/缬沙坦、血管紧张素转换酶抑制剂[ACEI]）或血管紧张素II受体阻滞剂[ARB]）填充。使用Poisson回归模型确定与沙库巴曲/缬沙坦启动相关的特征。从2015年7月至2019年6月，我们在RAASi初治的HFrEF退伍军人中确定了3458例沙库比曲/缬沙坦和29367例ACEI或ARB启动者。沙库巴曲/缬沙坦启动率从0%增加至26.5%。沙库巴曲/缬沙坦（与ACEI或ARB相比）启动者不太可能有卒中、心肌梗死或高血压病史，更可能是老年人、糖尿病和LVEF较低。6个月随访时，沙库巴曲/缬沙坦、ACEI和ARB启动者≥50%目标日剂量的患病率分别为23.5%、43.2%和47.1%。在美国食品药品监督管理局批准后的4年内，退伍军人管理局开始使用沙库巴曲/缬沙坦治疗HFrEF的人数增加。沙库巴曲/缬沙坦（与ACEI或ARB相比）启动者基线心血管合并症较少，6个月随访时≥50%目标日剂量的比例最低。确定沙库巴曲/缬沙坦随访剂量较低的原因可以支持HFrEF患者的指南建议和质量改善策略。
Sacubitril/valsartan, a first‐in‐class angiotensin receptor neprilysin inhibitor, received US Food and Drug Administration approval in 2015 for heart failure with reduced ejection fraction (HFrEF). Our objective was to describe the sacubitril/valsartan initiation rate, associated characteristics, and 6‐month follow‐up dosing among veterans with HFrEF who are renin‐angiotensin‐aldosterone system inhibitor (RAASi) naïve. Retrospective cohort study of veterans with HFrEF who are RAASi naïve defined as left ventricular ejection fraction (LVEF) ≤40%; ≥1 in/outpatient heart failure visit, first RAASi (sacubitril/valsartan, angiotensin‐converting enzyme inhibitor [ACEI]), or angiotensin‐II receptor blocker [ARB]) fill from July 2015 to June 2019. Characteristics associated with sacubitril/valsartan initiation were identified using Poisson regression models. From July 2015 to June 2019, we identified 3458 sacubitril/valsartan and 29 367 ACEI or ARB initiators among veterans with HFrEF who are RAASi naïve. Sacubitril/valsartan initiation increased from 0% to 26.5%. Sacubitril/valsartan (versus ACEI or ARB) initiators were less likely to have histories of stroke, myocardial infarction, or hypertension and more likely to be older and have diabetes mellitus and lower LVEF. At 6‐month follow‐up, the prevalence of ≥50% target daily dose for sacubitril/valsartan, ACEI, and ARB initiators was 23.5%, 43.2%, and 47.1%, respectively. Sacubitril/valsartan initiation for HFrEF in the Veterans Administration increased in the 4 years immediately following Food and Drug Administration approval. Sacubitril/valsartan (versus ACEI or ARB) initiators had fewer baseline cardiovascular comorbidities and the lowest proportion on ≥50% target daily dose at 6‐month follow‐up. Identifying the reasons for lower follow‐up dosing of sacubitril/valsartan could support guideline recommendations and quality improvement strategies for patients with HFrEF.