Sacubitril–Valsartan in Heart Failure: Why Are More Physicians Not Prescribing It?
Authors: Milton Packer, W. Mark Armstrong, Joseph M. Rothstein, Michael Emmett
Journal: Annals of Internal Medicine (2016)

Editorials15 November 2016Sacubitril–Valsartan in Heart Failure: Why Are More Physicians Not Prescribing It?Milton Packer, MD, W. Mark Armstrong, MD, Joseph M. Rothstein, MD, and Michael Emmett, MDMilton Packer, MDFrom Baylor Heart and Vascular Institute and the Department of Medicine, Baylor University Medical Center, Dallas, Texas.Search for more papers by this author, W. Mark Armstrong, MDFrom Baylor Heart and Vascular Institute and the Department of Medicine, Baylor University Medical Center, Dallas, Texas.Search for more papers by this author, Joseph M. Rothstein, MDFrom Baylor Heart and Vascular Institute and the Department of Medicine, Baylor University Medical Center, Dallas, Texas.Search for more papers by this author, and Michael Emmett, MDFrom Baylor Heart and Vascular Institute and the Department of Medicine, Baylor University Medical Center, Dallas, Texas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-1932 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail What if you were a patient with heart failure with reduced ejection fraction and your physician did not prescribe sacubitril–valsartan, a new drug that could prolong your life? Clinical trial data supported the drug's effectiveness, the U.S. Food and Drug Administration (FDA) expedited its approval, and U.S. guidelines recommended its use. Yet, you were stable while using several heart failure drugs, and the physician who saw you every 3 to 6 months never mentioned a newer medication, despite clinical trial data demonstrating mortality benefits of the drug in patients like you. You died suddenly one morning. Did your physician do ...References1. Sandhu AT, Ollendorf DA, Chapman RH, Pearson SD, Heidenreich PA. Cost-effectiveness of sacubitril–valsartan in patients with heart failure with reduced ejection fraction. Ann Intern Med. 2016;165:681-9. doi:10.7326/M16-0057 LinkGoogle Scholar2. King JB, Shah RU, Bress AP, Nelson RE, Bellows BK. Cost-effectiveness of sacubitril-valsartan combination therapy compared with enalapril for the treatment of heart failure with reduced ejection fraction. JACC Heart Fail. 2016;4:392-402. [PMID: 27039128] doi:10.1016/j.jchf.2016.02.007 CrossrefMedlineGoogle Scholar3. Gaziano TA, Fonarow GC, Claggett B, Chan WW, Deschaseaux-Voinet C, Turner SJ, et al. Cost-effectiveness analysis of sacubitril/valsartan vs enalapril in patients with heart failure and reduced ejection fraction. JAMA Cardiol. 2016. [PMID: 27438344] doi:10.1001/jamacardio.2016.1747 CrossrefMedlineGoogle Scholar4. Packer M. Love of angiotensin-converting enzyme inhibitors in the time of cholera. JACC Heart Fail. 2016. [PMID: 27107555] doi:10.1016/j.jchf.2016.02.012 CrossrefMedlineGoogle Scholar5. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, et al. 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2016. [PMID: 27208050] MedlineGoogle Scholar6. Packer M, McMurray JJ, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al; PARADIGM-HF Investigators and Coordinators. Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure. Circulation. 2015;131:54-61. [PMID: 25403646] doi:10.1161/CIRCULATIONAHA.114.013748 CrossrefMedlineGoogle Scholar7. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, et al; PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993-1004. [PMID: 25176015] doi:10.1056/NEJMoa1409077 CrossrefMedlineGoogle Scholar8. Solomon SD, Claggett B, Packer M, Desai A, Zile MR, Swedberg K, et al. Efficacy of sacubitril/valsartan relative to a prior decompensation: the PARADIGM-HF trial. JACC Heart Fail. 2016. [PMID: 27395349] doi:10.1016/j.jchf.2016.05.002 CrossrefMedlineGoogle Scholar9. Desai AS, McMurray JJ, Packer M, Swedberg K, Rouleau JL, Chen F, et al. Effect of the angiotensin-receptor-neprilysin inhibitor LCZ696 compared with enalapril on mode of death in heart failure patients. Eur Heart J. 2015;36:1990-7. [PMID: 26022006] doi:10.1093/eurheartj/ehv186 CrossrefMedlineGoogle Scholar10. Claggett B, Packer M, McMurray JJ, Swedberg K, Rouleau J, Zile MR, et al; PARADIGM-HF Investigators. Estimating the long-term treatment benefits of sacubitril-valsartan [Letter]. N Engl J Med. 2015;373:2289-90. [PMID: 26630151] doi:10.1056/NEJMc1509753 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Baylor Heart and Vascular Institute and the Department of Medicine, Baylor University Medical Center, Dallas, Texas.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1932.Corresponding Author: Milton Packer, MD, Baylor Heart and Vascular Institute, Baylor University Medical Center, 621 North Hall Street, Dallas, TX 75226; e-mail, milton.[email protected]edu.Current Author Addresses: Dr. Packer: Baylor Heart and Vascular Institute, Baylor University Medical Center, 621 North Hall Street, Dallas, TX 75226.Drs. Armstrong, Rothstein, and Emmett: Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246.This article was published at www.annals.org on 30 August 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCost-Effectiveness of Sacubitril–Valsartan in Patients With Heart Failure With Reduced Ejection Fraction Alexander T. Sandhu , Daniel A. Ollendorf , Richard H. Chapman , Steven D. Pearson , and Paul A. Heidenreich Sacubitril–Valsartan in Heart Failure Kevin E. Vitting Sacubitril–Valsartan in Heart Failure Brad Spellberg Sacubitril–Valsartan in Heart Failure Bennett E. Werner Sacubitril–Valsartan in Heart Failure Milton Packer , W. Mark Armstrong , Joseph M. Rothstein , and Michael Emmett Metrics Cited byFive Years of Sacubitril/Valsartan—a Safety Analysis of Randomized Clinical Trials and Real-World PharmacovigilanceCost-effectiveness analyses of sacubitril-valsartan for heart failureGuideline‐directed medical therapy for heart failure does not exist: a non‐judgmental framework for describing the level of adherence to evidence‐based drug treatments for patients with a reduced ejection fractionEffects of sacubitril/valsartan on functional status and exercise capacity in real-world patientsImpact of sacubitril/valsartan on heart failure admissions: insights from real-world patient prescriptionsPractical guidance on the use of sacubitril/valsartan for heart failureDo Limitations in the Design of PARADIGM-HF Justify the Slow Real World Uptake of Sacubitril/Valsartan (Entresto)?Cost-Effectiveness Analysis of Sacubitril-Valsartan Compared with Enalapril in Patients with Heart Failure with Reduced Ejection Fraction in ThailandThe reverse remodeling response to sacubitril/valsartan therapy in heart failure with reduced ejection fractionInsights into implementation of sacubitril/valsartan into clinical practiceThe role of angiotensin receptor–neprilysin inhibitors in cardiovascular disease—existing evidence, knowledge gaps, and future directionsHow have millions of people with heart failure benefited from our research over the last 10-15 years? The sounds of dead silenceReplyEditorial commentary: Guidelines for the treatment of chronic heart failureSacubitril–Valsartan in Heart FailureBrad Spellberg, MDSacubitril–Valsartan in Heart FailureBennett E. Werner, MDSacubitril–Valsartan in Heart FailureKevin E. Vitting, MDSacubitril/valsartan good value for heart failure with reduced LVEF 15 November 2016Volume 165, Issue 10Page: 735-736KeywordsClinical trialsDisclosureDrugsFood and Drug AdministrationHeartHeart failureMorbidityMortalityQuality adjusted life yearsSudden cardiac death ePublished: 30 August 2016 Issue Published: 15 November 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...