Retrospective Assessment of Sacubitril/Valsartan Prescribing Practices and Utilization in Patients With Heart Failure in a Rural Health System
by Megan McCormick, PharmD, Tonja Larson, PharmD, BCPS, BCACP, Jennifer Grimm, PharmD, BCPS, Paige Hergenrother, 2024 PharmD Candidate, Sara Griesbach, PharmD, BCPS, BCACP
Objective: The number of individuals diagnosed with heart failure is projected to increase in the coming years, and newer medications, such as angiotensin receptor-neprilysin inhibitors (e.g., sacubitril/valsartan) and sodium-glucose transport (SGLT-2) inhibitors (e.g., empagliflozin and dapagliflozin) have shown promising results in heart failure. The realworld prescribing practices of these newer medications warrant further investigation.
Methods: This retrospective descriptive study included reviewing electronic health records for 200 patients prescribed sacubitril/valsartan from January 1, 2015, to March 1, 2022. All patient records found to be eligible (n=163) underwent data abstraction through manual and electronic means. The primary outcome evaluated the prescribing patterns and use of sacubitril/valsartan in patients with heart failure. Secondary outcomes included whether the target dose of sacubitril/valsartan was achieved.
Results: At initiation of sacubitril/valsartan, approximately 2.5% (n=4) of study patients had a serum potassium of 5.2 mmol/L or greater, 2.5% (n=4) had an eGFR of less than 30 mL/min, and 11.9% (n=19) had a systolic blood pressure of less than 100 mmHg. Following initiation of sacubitril/valsartan, hypotension was reported in 51.5% of patients, which was the highest adverse drug reaction (ADR) identified. Dizziness, hyperkalemia, acute renal failure/acute kidney injury (AKI), cough, and angioedema were identified in 19.6%, 14.7%, 11.7%, 6.1%, and 1.8% of patients taking sacubitril/valsartan, respectively. No ADRs were identified in 30.7% of patients. The sacubitril/valsartan target dose was found to be achieved in 23.1% of all patients.
Conclusions: This study aligned with various findings from the PARADIGM HF trial and demonstrated that providers largely comply with recommended prescribing standards for sacubitril/valsartan. Adverse drug reactions seen after starting sacubitril/valsartan (e.g., decreased eGFR and systolic blood pressure, or increased serum potassium) may have influenced the titration of sacubitril/valsartan to target dose.
Keywords: Empagliflozin, Sacubitril, Dapagliflozin, Neprilysin, Sodium-Glucose Transporter 2 Inhibitors, Blood Pressure, Electronic Health Records, Hyperkalemia, Dizziness, Cough, Valsartan, Heart Failure, Hypotension, Angioedema, Potassium, Acute Kidney Injury
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2023 November/December Table of Contents
Objective: The number of individuals diagnosed with heart failure is projected to increase in the coming years, and newer medications, such as angiotensin receptor-neprilysin inhibitors (e.g., sacubitril/valsartan) and sodium-glucose transport (SGLT-2) inhibitors (e.g., empagliflozin and dapagliflozin) have shown promising results in heart failure. The realworld prescribing practices of these newer medications warrant further investigation.
Methods: This retrospective descriptive study included reviewing electronic health records for 200 patients prescribed sacubitril/valsartan from January 1, 2015, to March 1, 2022. All patient records found to be eligible (n=163) underwent data abstraction through manual and electronic means. The primary outcome evaluated the prescribing patterns and use of sacubitril/valsartan in patients with heart failure. Secondary outcomes included whether the target dose of sacubitril/valsartan was achieved.
Results: At initiation of sacubitril/valsartan, approximately 2.5% (n=4) of study patients had a serum potassium of 5.2 mmol/L or greater, 2.5% (n=4) had an eGFR of less than 30 mL/min, and 11.9% (n=19) had a systolic blood pressure of less than 100 mmHg. Following initiation of sacubitril/valsartan, hypotension was reported in 51.5% of patients, which was the highest adverse drug reaction (ADR) identified. Dizziness, hyperkalemia, acute renal failure/acute kidney injury (AKI), cough, and angioedema were identified in 19.6%, 14.7%, 11.7%, 6.1%, and 1.8% of patients taking sacubitril/valsartan, respectively. No ADRs were identified in 30.7% of patients. The sacubitril/valsartan target dose was found to be achieved in 23.1% of all patients.
Conclusions: This study aligned with various findings from the PARADIGM HF trial and demonstrated that providers largely comply with recommended prescribing standards for sacubitril/valsartan. Adverse drug reactions seen after starting sacubitril/valsartan (e.g., decreased eGFR and systolic blood pressure, or increased serum potassium) may have influenced the titration of sacubitril/valsartan to target dose.
Keywords: Empagliflozin, Sacubitril, Dapagliflozin, Neprilysin, Sodium-Glucose Transporter 2 Inhibitors, Blood Pressure, Electronic Health Records, Hyperkalemia, Dizziness, Cough, Valsartan, Heart Failure, Hypotension, Angioedema, Potassium, Acute Kidney Injury
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2023 November/December Table of Contents