Angiotensin Receptor-Neprilysin Inhibitor Prescribing Patterns in Patients Hospitalized for Heart Failure.

IF 14.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Pratyaksh K Srivastava, Alexandra M Klomhaus, Stephen J Greene, Paul Heidenreich, Sabra C Lewsey, Clyde W Yancy, Gregg C Fonarow
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引用次数: 0

Abstract

Importance: Angiotensin receptor-neprilysin inhibition (ARNI) improves mortality among patients with heart failure with reduced ejection fraction (HFrEF), ie, those with an EF of 40% or less.

Objective: To describe national longitudinal trends in ARNI prescribing patterns among hospitalized patients with HFrEF.

Design, setting, and participants: Using data from the Get With The Guidelines-Heart Failure (GWTG-HF) registry, hospitalized patients with HFrEF at 614 participating hospitals were identified. Rates of ARNI, angiotensin converting enzyme inhibitor (ACEI), and angiotensin II receptor blocker (ARB) prescription at discharge were evaluated across 3 time periods. Adjusted logistic regression and piecewise logistic regression were used to evaluate the impact of publication dates on ARNI prescription rates.

Exposures: ARNI prescribing patterns in hospitalized patients with HFrEF.

Main outcomes and measures: Rates of ARNI, ACEI, and ARB prescription at discharge were evaluated across 3 time periods as follows: (1) period 1 included the US Food and Drug Administration (FDA) approval of sacubitril-valsartan to the day before the PIONEER-HF (Comparison of Sacubitril-Valsartan vs Enalapril on Effect on N-Terminal Pro-Brain Natriuretic Peptide in Patients Stabilized From an Acute Heart Failure Episode) trial publication (July 7, 2015-November 10, 2018); (2) period 2 included the day of the PIONEER-HF trial publication to the day before publication of the 2021 Update to the 2017 Consensus for Optimization of Heart Failure Treatment (November 11, 2018-January 10, 2021); and (3) period 3 included the day of the 2021 update publication to the last available data at the time of analysis (January 11, 2021-December 31, 2022).

Results: A total of 114 333 hospitalized patients (mean [IQR] age, 67.0 [57.0-78.0] years; 74 765 male [65.4%]) were included in this study. Rates of ARNI prescribed at discharge increased from 1.1% (27 of 2451) during July 7, 2015, to September 30, 2015, to 55.4% (1957 of 3536) during October 1, 2022, to December 31, 2022. ACEI or ARB prescription at discharge fell from 88.3% (2612 of 2957) to 45.9% (2033 of 4434) over the same period, whereas ACEI, ARB, or ARNI prescription increased from 71.1% (2639 of 3713) to 84.7% (3990 of 4711). In adjusted logistic regression models, compared with period 1, patients discharged during period 2 and period 3 were found to have a 3.81-fold (95% CI, 3.65-3.98) and 9.15-fold (95% CI, 8.79-9.52) increased odds of ARNI prescription at discharge, and a 0.46 (95% CI, 0.45-0.48) and 0.25 (95% CI, 0.24-0.26) decreased odds of ACEI or ARB prescription at discharge.

Conclusions and relevance: Results of this cross-sectional study reveal that in the 7 years after FDA drug approval of sacubitril-valsartan, rates of ARNI or ACEI, ARB, or ARNI prescription at discharge increased, and rates of ACEI or ARB prescription decreased. Overall prescription of ARNI at discharge was 55.4% in eligible patients at the end of the study, suggesting remaining opportunity for continued improvement in ARNI prescription.

血管紧张素受体-奈普利素抑制剂在心力衰竭住院患者中的处方模式。
重要性:血管紧张素受体-血小板溶解素抑制(ARNI)可改善射血分数降低(HFrEF)心力衰竭患者的死亡率,即EF为40%或更低的患者。目的:描述HFrEF住院患者ARNI处方模式的全国纵向趋势。设计、环境和参与者:使用来自指南-心力衰竭(GWTG-HF)登记的数据,确定了614家参与医院的HFrEF住院患者。出院时ARNI、血管紧张素转换酶抑制剂(ACEI)和血管紧张素II受体阻滞剂(ARB)处方的比率在3个时间段内进行评估。采用校正logistic回归和分段logistic回归评估出版日期对ARNI处方率的影响。暴露:HFrEF住院患者的ARNI处方模式。主要结局和指标:出院时ARNI、ACEI和ARB处方率在3个时间段内评估如下:(1)第1期包括美国食品和药物管理局(FDA)批准苏比替-缬沙坦至PIONEER-HF前一天(苏比替-缬沙坦与依那普利对急性心力衰竭稳定患者n端前脑利钠肽的影响比较)试验发表(2015年7月7日- 2018年11月10日);(2)阶段2包括PIONEER-HF试验发表当天至2017年心力衰竭治疗优化共识2021年更新发布前一天(2018年11月11日至2021年1月10日);(3)周期3包括2021年更新发布之日至分析时最后可用数据(2021年1月11日至2022年12月31日)。结果:共114 333例住院患者(平均[IQR]年龄67.0[57.0-78.0]岁;74 765例男性[65.4%])纳入本研究。出院时规定的ARNI比率从2015年7月7日至2015年9月30日期间的1.1%(2451人中27人)增加到2022年10月1日至2022年12月31日期间的55.4%(3536人中1957人)。在同一时期,出院时ACEI或ARB处方从88.3%(2957例中的2612例)下降到45.9%(4434例中的2033例),而ACEI、ARB或ARNI处方从71.1%(3713例中的2639例)上升到84.7%(4711例中的3990例)。在调整后的logistic回归模型中,与第1期相比,第2期和第3期出院的患者出院时ARNI处方的几率分别增加3.81倍(95% CI, 3.65-3.98)和9.15倍(95% CI, 8.79-9.52),出院时ACEI或ARB处方的几率分别减少0.46倍(95% CI, 0.45-0.48)和0.25倍(95% CI, 0.24-0.26)。结论及相关性:本横断面研究的结果显示,在FDA批准苏比替-缬沙坦后的7年中,出院时ARNI或ACEI、ARB或ARNI处方的发生率增加,而ACEI或ARB处方的发生率下降。在研究结束时,符合条件的患者出院时ARNI的总体处方为55.4%,表明ARNI处方仍有继续改善的机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JAMA cardiology
JAMA cardiology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
45.80
自引率
1.70%
发文量
264
期刊介绍: JAMA Cardiology, an international peer-reviewed journal, serves as the premier publication for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. As a member of the JAMA Network, it aligns with a consortium of peer-reviewed general medical and specialty publications. Published online weekly, every Wednesday, and in 12 print/online issues annually, JAMA Cardiology attracts over 4.3 million annual article views and downloads. Research articles become freely accessible online 12 months post-publication without any author fees. Moreover, the online version is readily accessible to institutions in developing countries through the World Health Organization's HINARI program. Positioned at the intersection of clinical investigation, actionable clinical science, and clinical practice, JAMA Cardiology prioritizes traditional and evolving cardiovascular medicine, alongside evidence-based health policy. It places particular emphasis on health equity, especially when grounded in original science, as a top editorial priority.
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