Sacubitril–Valsartan in Heart Failure
Authors: Milton Packer, W. Mark Armstrong, Joseph M. Rothstein, Michael Emmett
Journal: Annals of Internal Medicine (2017)

Letters2 May 2017Sacubitril–Valsartan in Heart FailureMilton Packer, MD, W. Mark Armstrong, MD, Joseph M. Rothstein, MD, and Michael Emmett, MDMilton Packer, MDFrom Baylor Heart and Vascular Institute and Baylor University Medical Center, Dallas, Texas.Search for more papers by this author, W. Mark Armstrong, MDFrom Baylor Heart and Vascular Institute and Baylor University Medical Center, Dallas, Texas.Search for more papers by this author, Joseph M. Rothstein, MDFrom Baylor Heart and Vascular Institute and Baylor University Medical Center, Dallas, Texas.Search for more papers by this author, and Michael Emmett, MDFrom Baylor Heart and Vascular Institute and Baylor University Medical Center, Dallas, Texas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0046 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:All 3 comments convey the same message: The reason more physicians do not prescribe sacubitril–valsartan is cost. None questions whether this agent is superior to conventional renin–angiotensin inhibitors in prolonging life, reducing hospitalizations, and improving symptoms (1–3). Our editorial focused on the compelling scientific evidence supporting the widespread use of the drug, not cost. As far as science is concerned, all agree that sacubitril–valsartan should be the new cornerstone of heart failure treatment (4).We agree with Dr. Spellberg that “when the health care delivery system rather than society is the payer, cost-effectiveness estimates that take a societal ...References1. 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 Scholar2. 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 Scholar3. Fonarow GC, Hernandez AF, Solomon SD, Yancy CW. Potential mortality reduction with optimal implementation of angiotensin receptor neprilysin inhibitor therapy in heart failure. JAMA Cardiol. 2016;1:714-7. [PMID: 27437874] doi:10.1001/jamacardio.2016.1724 CrossrefMedlineGoogle Scholar4. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, et al; Writing Committee Members. 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;134:e282-93. [PMID: 27208050] doi:10.1161/CIR.0000000000000435 CrossrefMedlineGoogle Scholar5. Packer M. Kicking the tyres of a heart failure trial: physician response to the approval of sacubitril/valsartan in the USA. Eur J Heart Fail. 2016;18:1211-9. [PMID: 27510447] doi:10.1002/ejhf.623 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Baylor Heart and Vascular Institute and Baylor University Medical Center, Dallas, Texas.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1932. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSacubitril–Valsartan in Heart Failure: Why Are More Physicians Not Prescribing It? Milton Packer , W. Mark Armstrong , Joseph M. Rothstein , and Michael Emmett Sacubitril–Valsartan in Heart Failure Brad Spellberg Sacubitril–Valsartan in Heart Failure Kevin E. Vitting Sacubitril–Valsartan in Heart Failure Bennett E. Werner Metrics 2 May 2017Volume 166, Issue 9Page: 681-682KeywordsDisclosureDrugsFearFood and Drug AdministrationHealth careHeart diseasesHeart failureHospitalizationsMotivationSafety ePublished: 2 May 2017 Issue Published: 2 May 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...