BackgroundCurrent guidelines recommend sacubitril/valsartan for patients with heart failure with reduced ejection fraction, but the rate of adoption in the United States has been slow.Methods and ResultsUsing data from CHAMP-HF (Change the Management of Patients With Heart Failure), we described current sacubitril/valsartan use and identified patient, provider, and practice characteristics associated with its use. We considered patients to be on sacubitril/valsartan if they were prescribed it before enrollment or initiated on it at the baseline visit. We excluded patients with a contraindication to sacubitril/valsartan and practices with <10 patients enrolled. Of 4216 patients from 121 sites, 616 (15%) were prescribed sacubitril/valsartan, 2506 (59%) an angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB), and 1094 (26%) neither. Patients prescribed sacubitril/valsartan were younger (63 years versus 66 years ACE inhibitor/ARB versus 69 years neither, P<0.001), less likely to have chronic kidney disease (15% versus 17% ACE inhibitor/ARB versus 30% neither, P<0.001), more likely to have cardiac resynchronization therapy (12% versus 7% ACE inhibitor/ARB versus 7% neither, P<0.001), and had lower ejection fraction (27% versus 30% ACE inhibitor/ARB versus 30% neither, P<0.001). Larger practices, based on number of cardiologists and advanced practice providers, were associated with the highest sacubitril/valsartan use. After multivariable adjustment, the number of advanced practice providers was associated with sacubitril/valsartan use (adjusted odds ratio,1.08; 95% CI, 1.03–1.14).ConclusionsDespite current guideline recommendations, adoption of sacubitril/valsartan remains low. Provider and practice characteristics associated with sacubitril/valsartan use were related to general practice size and were not associated with practice characteristics specific for heart failure. Further research is needed to identify strategies for effective quality improvement interventions in chronic heart failure with reduced ejection fraction.

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在美国与沙必比尔/缬沙坦的使用有关的患者，提供者和实践特征

背景目前的指南建议将沙库比特/缬沙坦用于射血分数降低的心力衰竭患者，但在美国的采用速度缓慢。方法和结果使用CHAMP-HF（改变心力衰竭患者的治疗方法）的数据进行了描述目前使用沙屈比特/缬沙坦的使用情况，并确定与其使用有关的患者，提供者和执业特征。我们认为患者在入组前或在基线访视时开始服用沙必比/缬沙坦。我们排除了禁忌使用沙比特利/缬沙坦的患者，并且纳入少于10例患者的实践。在来自121个地点的4216名患者中，有616（15％）名患者接受了屈比特利/缬沙坦的处方，2506（59％）名患者接受了血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂（ARB）的治疗，和1094（26％）都没有。开具沙奎普利/缬沙坦的患者年龄较小（分别为63岁和66岁ACE抑制剂/ ARB对69岁，P <0.001），患有慢性肾脏疾病的可能性较小（15％对ACE抑制剂/ ARB分别为17％与30％两者都不是，P <0.001），进行心脏再同步化治疗的可能性较高（12％对ACE抑制剂/ ARB与7％相比）两者均无7％（P <0.001），且射血分数较低（27％比30％ACE抑制剂/ ARB对30％均无，P<0.001）。根据心脏病专家和高级实践提供者的数量，较大的做法与最高使用沙必比尔/缬沙坦有关。经过多变量调整后，高级实践者的人数与使用沙比特比/缬沙坦有关（调整的比值比为1.08； 95％CI为1.03-1.14）。结论尽管目前有指南建议，使用沙比特比/缬沙坦的比例仍然较低。与沙必特/缬沙坦的使用有关的提供者和行为特征与一般行为规模有关，与心力衰竭特有的行为特征无关。需要进一步的研究来确定有效的改善射血分数降低的慢性心力衰竭的质量干预措施的策略。