Reviewing Sildenafil Rates: an Evaluation of Sildenafil Prescribing Trends in LVAD Patients

PurposeThere remains no clear role for sildenafil use post-LVAD, raising concerns for patient adverse events, healthcare resource utilization, and unnecessary costs. This study evaluates whether sildenafil use post-LVAD has changed over time. We hypothesize an overall decrease in trend of sildenafil prescribing given uncertainty in outcomes.MethodsPatients ≥ 18 years who underwent LVAD implant from April 2009 to June 2021 and were prescribed sildenafil following implant were included. The primary outcome of the study was to evaluate the yearly prescribing trends of sildenafil following LVAD. Secondary outcomes included time to sildenafil discontinuation, pharmacy resource utilization, and cost to patients.Results86 patient encounters were included for analysis (Table 1.). The data was separated into two groups: patients receiving LVAD implants 2009 to 2014 versus 2015 to present. Overall, there was an approximate 11.5% decreased trend in sildenafil prescribing from 2009 to June 2021 (Figure 1.). Of 86 patients who were prescribed sildenafil, 62 discontinued before (n=24) or after discharge (n=38), 19 were still on therapy at the end of the study period, and 5 were discontinued prior to heart transplantation. Time to discontinuation was significantly lower in the 2015-2021 cohort (p<0.05). The median acquisition wholesale price, initial, and maximum dose of sildenafil were lower in patients receiving LVAD implants from 2015 to 2021.ConclusionPeak use of sildenafil occurred in 2010. Our analysis demonstrated a general decline in the prescribing trend as well as the total time patients remained on therapy over the study period. There remains no clear role for sildenafil use post-LVAD, raising concerns for patient adverse events, healthcare resource utilization, and unnecessary costs. This study evaluates whether sildenafil use post-LVAD has changed over time. We hypothesize an overall decrease in trend of sildenafil prescribing given uncertainty in outcomes. Patients ≥ 18 years who underwent LVAD implant from April 2009 to June 2021 and were prescribed sildenafil following implant were included. The primary outcome of the study was to evaluate the yearly prescribing trends of sildenafil following LVAD. Secondary outcomes included time to sildenafil discontinuation, pharmacy resource utilization, and cost to patients. 86 patient encounters were included for analysis (Table 1.). The data was separated into two groups: patients receiving LVAD implants 2009 to 2014 versus 2015 to present. Overall, there was an approximate 11.5% decreased trend in sildenafil prescribing from 2009 to June 2021 (Figure 1.). Of 86 patients who were prescribed sildenafil, 62 discontinued before (n=24) or after discharge (n=38), 19 were still on therapy at the end of the study period, and 5 were discontinued prior to heart transplantation. Time to discontinuation was significantly lower in the 2015-2021 cohort (p<0.05). The median acquisition wholesale price, initial, and maximum dose of sildenafil were lower in patients receiving LVAD implants from 2015 to 2021. Peak use of sildenafil occurred in 2010. Our analysis demonstrated a general decline in the prescribing trend as well as the total time patients remained on therapy over the study period.