Chun-Lan Chang

Characteristics of early sacubitril/valsartan patients and considerations for studies in electronic health record data

AIM We examined characteristics of early sacubitril/valsartan users in a large US electronic health records database. PATIENTS & METHODS We identified three cohorts of patients with heart failure (HF): sacubitril/valsartan patients with a prior HF diagnosis; patients with HF with reduced ejection fraction; and patients with HF treated with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker and a β-blocker. RESULTS Sacubitril/valsartan patients were younger than patients in the other cohorts; the mean age of sacubitril/valsartan patients increased by 2 years in the first 15 months of marketing. Most sacubitril/valsartan patients had prior use of HF treatment. CONCLUSION Overall, sacubitril/valsartan patients resembled those in the HF with reduced ejection fraction cohort, and commonly used other drugs for HF.

TEMPORARY REMOVAL: Early Impact of Guideline Publication on Angiotensin-Receptor Neprilysin Inhibitor Use among Patients Hospitalized for Heart Failure

Background: On May 20, 2016, US professional organizations in cardiology published joint treatment guidelines recommending the use of angiotensin‐receptor neprilysin inhibitor (ARNI) for eligible patients with heart failure with reduced ejection fraction (HFrEF). Using data from the Get With The Guidelines–Heart Failure registry, we evaluated the early impact of this update on temporal trends in ARNI prescription. Methods: We analyzed patients with HFrEF who were eligible for ARNI prescription (EF ≤40%, no contraindications) and hospitalized from February 20, 2016, through August 19, 2016—allowing for 13 weeks before and after guideline publication. We quantified trends in ARNI use associated with guidelines publication with an interrupted time‐series design using logistic regression and accounting for correlations within hospitals using general estimating equation methods. Results: Of 7,200 eligible patient hospitalizations, 51.9% were discharged in the period directly preceding publication of the guidelines, and 48.1% were discharged after. Odds ratios of ARNI prescription at discharge were significantly higher in the postguideline period compared with the preguideline period in adjusted models (adjusted odds ratio 1.29, 95% CI 1.06‐1.57, P = .01). However, there was no significant interaction between observed and expected ARNI use after guideline publication (Pinteraction = .14). Results were consistent using a 6‐month before and after time frame. Conclusions: The model suggested a small increase in ARNI use in HF patients being discharged from the hospital immediately after guideline release. However, the publication of national guidelines recommending ARNI use seemed to have little influence on the adoption of this evidence‐based medication in the first 3 to 6 months.

Quantifying the relative importance to patients of avoiding symptoms and outcomes of heart failure

Abstract Objective: To evaluate heart failure (HF) patients’ disease knowledge and preferences for avoiding different disease outcomes. Methods: An online survey was administered to 400 individuals with a self-reported diagnosis of HF to elicit relative importance weights (RIWs) for avoiding 11 potential HF symptoms and outcomes using best–worst scaling. The survey also included questions about individuals’ HF knowledge, and demographic and disease-experience characteristics. Differences in RIWs among sub-groups, defined by HF knowledge, caregiver support, age, recent hospitalization or emergency room visit for HF, health-related quality-of-life, and cardiac device experience were examined. Results: Relative to limitations in usual activities (RIW 1.00), respondents preferred avoiding severe, infrequent cardiovascular events (e.g. stroke [RIW 8.51], heart transplant [RIW 7.84], or heart attack [RIW 5.3]) most, followed by difficulty breathing (RIW 2.55), inability to enjoy life (RIW 1.84), cardiac device implantation (RIW 1.74), and atrial fibrillation (RIW 1.57). Patients preferred avoiding swelling (RIW 0.47) and fatigue (RIW 0.58) least. RIWs for avoiding severe, infrequent events were higher among those with high disease knowledge, those without caregivers, and those without a recent hospitalization or emergency room visit. Conclusions: Patients’ preferences for avoiding HF outcomes vary across outcomes and by individuals’ knowledge, caregiver status, and age. Healthcare providers should solicit and incorporate insights about patients’ knowledge of HF and their preferences for avoiding HF outcomes into HF education and management planning efforts.

END OF LIFE HEALTHCARE COSTS IN HEART FAILURE: DIFFERENCES BASED ON RACE/ETHNICITY

Prior research suggests increases in resource use and costs in the final months of life, yet limited data exist on such trends in patients with HF. This study evaluated healthcare costs in the last 2 years of life among patients with HF by race/ethnicity. Findings will provide better understanding