Background:US guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF), who tolerate an ACEI (angiotensin-converting enzyme inhibitor) or ARB (angiotensin II receptor blocker), be switched to sacubitril/valsartan to reduce morbidity and mortality. We compared characteristics and healthcare utilization between Veterans with HFrEF who were switched to sacubitril/valsartan versus maintained on an ACEI or ARB.Methods:retrospective cohort study of treated HFrEF (July 2015–June 2017) using Veterans Affairs data. The index date was the first fill for sacubitril/valsartan and if none, for an ACEI or ARB. Treated HFrEF was defined by (1) left ventricular ejection fraction ≤40%, (2) ≥1 in/outpatient HF encounter, and (3) ≥1 ACEI or ARB fill, all within 1-year preindex. Poisson regression models were used to compare baseline characteristics and 1:1 propensity score-matched adjusted 4-month follow-up healthcare utilization between sacubitril/valsartan switchers and ACEI or ARB maintainers.Results:Switchers (1612; 4.2%) were less likely than maintainers (37 065; 95.8%) to have a history of myocardial infarction or hypertension, and more likely to be black, have a lower left ventricular ejection fraction, and higher preindex healthcare utilization. Switchers were less likely to experience follow-up all-cause hospitalizations (11.2% versus 14.0%; risk ratio 0.80 [95% CI, 0.65–0.98], P value 0.035).Conclusions:Few Veterans with treated HFrEF were switched to sacubitril/valsartan within the first 2 years of Food and Drug Administration approval. Sacubitril/valsartan use was associated with a lower risk for all-cause hospitalizations at 4 months follow-up. Reasons for lack of guideline-recommended sacubitril/valsartan initiation warrant investigation and may reveal opportunities for HFrEF care optimization.

中文翻译：

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转为沙库比特/缬沙坦治疗射血分数降低的心力衰竭退伍军人的特征和医疗保健利用。

背景：美国指南建议，耐受ACEI（血管紧张素转换酶抑制剂）或ARB（血管紧张素II受体阻滞剂）的射血分数降低的心力衰竭患者应改用沙库比特/缬沙坦以降低发病率和死亡率。我们比较了使用HFrEF的退伍军人和接受ACEI或ARB维持治疗的HFrEF的特征和医疗保健利用率。方法：使用退伍军人事务数据对治疗过的HFrEF进行的回顾性队列研究（2015年7月至2017年6月）。索引日期是沙必比/缬沙坦的第一个填充日期，ACEI或ARB是第一个填充日期（如果没有填充）。HFrEF的治疗定义为：（1）左心室射血分数≤40％；（2）住院期间/门诊患者遭遇HF≥1；（3）ACEI或ARB≥1，均在1年预指数内。Poisson回归模型用于比较Sacubitril / Valsartan切换者与ACEI或ARB维持者之间的基线特征和1：1倾向得分匹配的调整后4个月随访医疗利用率。结果：切换者（1612; 4.2％）的可能性小于保持者（37 065; 95.8％）有心肌梗塞或高血压病史，并且更可能是黑人，左心室射血分数较低，预索引医疗保健利用率较高。切换者不太可能接受后续全因住院治疗（11.2％对14.0％；风险比0.80 [95％CI，0.65-0.98]，与维持者（37 065; 95.8％）有心肌梗塞或高血压病史的可能性相比，有2％）的可能性较小，并且更可能是黑人，左心室射血分数较低和预索引医疗保健利用率较高。切换者不太可能接受后续全因住院治疗（11.2％对14.0％；风险比0.80 [95％CI，0.65-0.98]，与维持者（37 065; 95.8％）有心肌梗塞或高血压病史的可能性相比，有2％）的可能性较小，并且更可能是黑人，左心室射血分数较低和预指数医疗保健利用率较高。切换者不太可能接受后续全因住院治疗（11.2％对14.0％；风险比0.80 [95％CI，0.65-0.98]，P值0.035）。结论：在FDA批准的最初2年内，很少有经过HFrEF治疗的退伍军人转用沙比特利/缬沙坦。随访4个月后，使用沙必比/缬沙坦与全因住院的风险较低。缺乏指南推荐的沙必比尔/缬沙坦起始治疗的原因需要进行调查，并可能揭示优化HFrEF护理的机会。