Relationship Between Hospital Characteristics and Early Adoption of Angiotensin‐Receptor/Neprilysin Inhibitor Among Eligible Patients Hospitalized for Heart Failure
Background The angiotensin‐receptor/neprilysin inhibitor (ARNI) sacubitril/valsartan reduces hospitalization and mortality for patients with heart failure with reduced ejection fraction. However, adoption of ARNI into clinical practice has been slow. Factors influencing use of ARNI have not been ful...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.010484 |
| _version_ | 1819178169929826304 |
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| author | Nancy Luo Steven J. Lippmann Robert J. Mentz Melissa A. Greiner Bradley G. Hammill N. Chantelle Hardy Warren K. Laskey Paul A. Heidenreich Chun‐Lan Chang Adrian F. Hernandez Lesley H. Curtis Pamela N. Peterson Gregg C. Fonarow Emily C. O'Brien |
| author_facet | Nancy Luo Steven J. Lippmann Robert J. Mentz Melissa A. Greiner Bradley G. Hammill N. Chantelle Hardy Warren K. Laskey Paul A. Heidenreich Chun‐Lan Chang Adrian F. Hernandez Lesley H. Curtis Pamela N. Peterson Gregg C. Fonarow Emily C. O'Brien |
| author_sort | Nancy Luo |
| collection | DOAJ |
| description | Background The angiotensin‐receptor/neprilysin inhibitor (ARNI) sacubitril/valsartan reduces hospitalization and mortality for patients with heart failure with reduced ejection fraction. However, adoption of ARNI into clinical practice has been slow. Factors influencing use of ARNI have not been fully elucidated. Using data from the Get With The Guidelines‐Heart Failure registry, Hospital Compare, Dartmouth Atlas, and the American Hospital Association Survey, we sought to identify hospital characteristics associated with patient‐level receipt of an ARNI prescription. Methods and Results We analyzed patients with heart failure with reduced ejection fraction who were eligible for ARNI prescription (ejection fraction≤40%, no contraindications) and hospitalized from October 1, 2015 through December 31, 2016. We used logistic regression to estimate the associations between hospital characteristics and patient ARNI prescription at hospital discharge, accounting for clustering of patients within hospitals using generalized estimating equation methods and adjusting for patient‐level covariates. Of 16 674 eligible hospitalizations from 210 hospitals, 1020 patients (6.1%) were prescribed ARNI at discharge. The median hospital‐level proportion of patients prescribed ARNI was 3.3% (Q1, Q3: 0%, 12.6%). After adjustment for patient‐level covariates, for‐profit hospitals had significantly higher odds of ARNI prescription compared with not‐for‐profit hospitals (odds ratio, 2.53; 95% CI, 1.05–6.10; P=0.04), and hospitals located in the Western United States had lower odds of ARNI prescription compared with those in the Northeast (odds ratio, 0.33; 95% CI, 0.13–0.84; P=0.02). Conclusions Relatively few hospital characteristics were associated with ARNI prescription at hospital discharge, in contrast to what has been observed in early adoption in other disease areas. Additional evaluation of barriers to implementing new evidence into heart failure practice is needed. |
| first_indexed | 2024-12-22T21:38:17Z |
| format | Article |
| id | doaj.art-37c7bb1a3b0545be89b2b4419d4676c5 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:38:17Z |
| publishDate | 2019-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-37c7bb1a3b0545be89b2b4419d4676c52022-12-21T18:11:40ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-02-018310.1161/JAHA.118.010484Relationship Between Hospital Characteristics and Early Adoption of Angiotensin‐Receptor/Neprilysin Inhibitor Among Eligible Patients Hospitalized for Heart FailureNancy Luo0Steven J. Lippmann1Robert J. Mentz2Melissa A. Greiner3Bradley G. Hammill4N. Chantelle Hardy5Warren K. Laskey6Paul A. Heidenreich7Chun‐Lan Chang8Adrian F. Hernandez9Lesley H. Curtis10Pamela N. Peterson11Gregg C. Fonarow12Emily C. O'Brien13Division of Cardiovascular Medicine University of California—Davis Medical Center Sacramento CADepartment of Population Health Sciences Duke University School of Medicine Durham NCDepartment of Medicine Duke University School of Medicine Durham NCDepartment of Population Health Sciences Duke University School of Medicine Durham NCDepartment of Population Health Sciences Duke University School of Medicine Durham NCDepartment of Population Health Sciences Duke University School of Medicine Durham NCDivision of Cardiology University of New Mexico School of Medicine Albuquerque NMDepartment of Medicine Veterans Affairs Palo Alto Health Care System Palo Alto CAUS Health Economics & Outcomes Research Novartis Pharmaceuticals Corporation East Hanover NJDepartment of Medicine Duke University School of Medicine Durham NCDepartment of Population Health Sciences Duke University School of Medicine Durham NCDepartment of Medicine Denver Health Medical Center Denver COAhmanson‐UCLA Cardiomyopathy Center University of California Los Angeles CADepartment of Population Health Sciences Duke University School of Medicine Durham NCBackground The angiotensin‐receptor/neprilysin inhibitor (ARNI) sacubitril/valsartan reduces hospitalization and mortality for patients with heart failure with reduced ejection fraction. However, adoption of ARNI into clinical practice has been slow. Factors influencing use of ARNI have not been fully elucidated. Using data from the Get With The Guidelines‐Heart Failure registry, Hospital Compare, Dartmouth Atlas, and the American Hospital Association Survey, we sought to identify hospital characteristics associated with patient‐level receipt of an ARNI prescription. Methods and Results We analyzed patients with heart failure with reduced ejection fraction who were eligible for ARNI prescription (ejection fraction≤40%, no contraindications) and hospitalized from October 1, 2015 through December 31, 2016. We used logistic regression to estimate the associations between hospital characteristics and patient ARNI prescription at hospital discharge, accounting for clustering of patients within hospitals using generalized estimating equation methods and adjusting for patient‐level covariates. Of 16 674 eligible hospitalizations from 210 hospitals, 1020 patients (6.1%) were prescribed ARNI at discharge. The median hospital‐level proportion of patients prescribed ARNI was 3.3% (Q1, Q3: 0%, 12.6%). After adjustment for patient‐level covariates, for‐profit hospitals had significantly higher odds of ARNI prescription compared with not‐for‐profit hospitals (odds ratio, 2.53; 95% CI, 1.05–6.10; P=0.04), and hospitals located in the Western United States had lower odds of ARNI prescription compared with those in the Northeast (odds ratio, 0.33; 95% CI, 0.13–0.84; P=0.02). Conclusions Relatively few hospital characteristics were associated with ARNI prescription at hospital discharge, in contrast to what has been observed in early adoption in other disease areas. Additional evaluation of barriers to implementing new evidence into heart failure practice is needed.https://www.ahajournals.org/doi/10.1161/JAHA.118.010484early adoptionimplementation sciencenovel therapyquality improvement |
| spellingShingle | Nancy Luo Steven J. Lippmann Robert J. Mentz Melissa A. Greiner Bradley G. Hammill N. Chantelle Hardy Warren K. Laskey Paul A. Heidenreich Chun‐Lan Chang Adrian F. Hernandez Lesley H. Curtis Pamela N. Peterson Gregg C. Fonarow Emily C. O'Brien Relationship Between Hospital Characteristics and Early Adoption of Angiotensin‐Receptor/Neprilysin Inhibitor Among Eligible Patients Hospitalized for Heart Failure Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease early adoption implementation science novel therapy quality improvement |
| title | Relationship Between Hospital Characteristics and Early Adoption of Angiotensin‐Receptor/Neprilysin Inhibitor Among Eligible Patients Hospitalized for Heart Failure |
| title_full | Relationship Between Hospital Characteristics and Early Adoption of Angiotensin‐Receptor/Neprilysin Inhibitor Among Eligible Patients Hospitalized for Heart Failure |
| title_fullStr | Relationship Between Hospital Characteristics and Early Adoption of Angiotensin‐Receptor/Neprilysin Inhibitor Among Eligible Patients Hospitalized for Heart Failure |
| title_full_unstemmed | Relationship Between Hospital Characteristics and Early Adoption of Angiotensin‐Receptor/Neprilysin Inhibitor Among Eligible Patients Hospitalized for Heart Failure |
| title_short | Relationship Between Hospital Characteristics and Early Adoption of Angiotensin‐Receptor/Neprilysin Inhibitor Among Eligible Patients Hospitalized for Heart Failure |
| title_sort | relationship between hospital characteristics and early adoption of angiotensin receptor neprilysin inhibitor among eligible patients hospitalized for heart failure |
| topic | early adoption implementation science novel therapy quality improvement |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.010484 |
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