Hospitalization Provides An Opportunity For Sacubitril/valsartan Initiation

Introduction Sacubitril/valsartan reduces the risk of cardiovascular death and hospitalization when compared to enalapril, while providing a greater reduction in NT-proBNP and improved cardiac volume and function Additionally, it has shown to be safe to initiate in hospitalized patients Despite HFSA guideline recommendations to utilize sacubitril/valsartan as first line HF therapy, national utilization rates of 14% have been described Purpose: The purpose of this study is to identify barriers to initiation and continuation of sacubitril/valsartan in hospitalized HFrEF patients Methods This study is a single-center, retrospective chart review evaluating sacubitril/valsartan prescribing patterns and barriers to therapy in hospitalized patients Patients were included if they were 18 years of age or older, admitted to the study site between January 1, 2021 and October 31, 2021 and have an ECHO with a left ventricle ejection fraction of less than or equal to 40% during that admission Results A total of 167 patients were included for analysis of which 71% were female and the average age was 66 years Of the patients included, 89% of patients were admitted due to heart failure The average left ventricular ejection fraction was 27% and average NT-Pro-BNP was 1206 pg/mL During admission, 13 8% of patients were newly initiated on sacubitril/valsartan while 5 4% were continued on home therapy compared to 4 8% who had therapy held while admitted The most common reasons for withholding sacubitril/valsartan during hospitalization were hypotension (13 8%) and elevated serum creatinine (19 8%), followed by hyperkalemia (3 6%) and cost of therapy (3 6%) Use of sacubitril/valsartan increased from 10 2% prior to admission, up to 18% on discharge Conclusions While sacubitril/valsartan use remains low, a significant increase in use showcases hospitalization as an opportunity for sacubitril/valsartan initiation The most common barriers to initiation of therapy were hypotension and elevated serum creatinine