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Sacubitril/valsartan use patterns among older adults with heart failure in clinical practice: a population‐based cohort study of >25 000 Medicare beneficiaries

2022; Elsevier BV; Volume: 24; Issue: 9 Linguagem: Inglês

10.1002/ejhf.2572

1879-0844

Ankeet S. Bhatt, Muthiah Vaduganathan, Scott D. Solomon, Sebastian Schneeweiß, Julie C. Lauffenburger, Rishi Desai,

Bipolar Disorder and Treatment

Abstract Aims Sacubitril/valsartan is strongly supported in guidelines for the management of heart failure, but suboptimal adherence and treatment non‐persistence may limit the population‐level benefit that this therapy might otherwise offer. Methods and results We identified a cohort of Medicare beneficiaries (2014–2017) initiating sacubitril/valsartan after ≥6 months of continuous enrolment. We assessed adherence as the proportion of days covered (PDC) and proportion of patients non‐persistent (having no prescription available) at 180 days after initiation. We fit a multivariable negative binomial model with a count of adherent days to evaluate independent factors associated with of sacubitril/valsartan adherence. Among 27 063 new sacubitril/valsartan users, most ( n = 17 663, 65%) were prescribed low‐dose at 24 mg/26 mg and most ( n = 19 984, 74%) were switched from prior angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) rather than being RASi treatment naïve. Median 180‐day PDC was 86% (25th–75th percentiles 58–98%). Black patients, those with high comorbid disease burden (≥8 comorbidities), and patients with recent hospitalization within 30 days had fewer adherent days, while those treated with preceding ACEi/ARB had more adherent days. Thirty‐four percent of patients did not have an active sacubitril/valsartan prescription at day 180. Among these, few had preceding dose down‐titrations (6% among patients on 49 mg/51 mg and 9% among patients on 97 mg/103 mg) and 68% did not have a subsequent ACEi/ARB prescription. Among patients who remained persistent, dose up‐titrations occurred in 29% of patients who started on 24 mg/26 mg and 27% of patients on 49 mg/51 mg. Conclusions Overall adherence to sacubitril/valsartan among Medicare beneficiaries is acceptable, but is lower in Black patients, those with higher comorbidities or those who started therapy after recent hospitalization. While broad implementation of guideline‐directed medical therapy is a key priority, additional focused efforts to improve adherence early after hospitalization and among at‐risk patients are needed in parallel.