{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T14:24:05Z","timestamp":1761920645301,"version":"build-2065373602"},"reference-count":21,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T00:00:00Z","timestamp":1570665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2019,11]]},"abstract":"\n Study Objective<\/jats:title>\n \n Despite evidence that supports the use of sacubitril\/valsartan \u2013 the first angiotensin\n II<\/jats:styled-content>\n receptor blocker\u2013neprilysin inhibitor \u2013 for mortality reduction in patients with heart failure (\n HF<\/jats:styled-content>\n ), it remains underprescribed. The objective of this study was to evaluate eligibility for initiation of sacubitril\/valsartan treatment in patients with\n HF<\/jats:styled-content>\n within the largest Veterans Administration healthcare system in the United States.\n <\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Cross\u2010sectional study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n \n Veterans Affairs Greater Los Angeles Healthcare System (\n VAGLAHS<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Patients<\/jats:title>\n \n A total of 2985 patients with a\n HF<\/jats:styled-content>\n diagnosis who were alive as of November 1, 2017.\n <\/jats:p>\n <\/jats:sec>\n \n Measurements and Main Results<\/jats:title>\n \n Eligibility for sacubitril\/valsartan initiation was based on inclusion and exclusion criteria from the Prospective Comparison of Angiotensin Receptor\u2013Neprilysin Inhibitor with Angiotensin\u2010Converting\u2013Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (\n PARADIGM<\/jats:styled-content>\n \u2010\n HF<\/jats:styled-content>\n ) trial and the\n VA<\/jats:styled-content>\n Criteria for Use. The proportion of eligible patients was estimated, and characteristics of eligible patients were compared with those in the\n PARADIGM<\/jats:styled-content>\n \u2010\n HF<\/jats:styled-content>\n trial. Of the 2985 patients with\n HF<\/jats:styled-content>\n who were alive as of November 1, 2017, 965 (32.3%) had\n HF<\/jats:styled-content>\n with reduced ejection fraction (\n HF<\/jats:styled-content>\n r\n EF<\/jats:styled-content>\n ). Of these patients with\n HF<\/jats:styled-content>\n r\n EF<\/jats:styled-content>\n , 263 (27.3%) fulfilled eligibility criteria and were considered candidates for sacubitril\/valsartan initiation. Of the 702 patients who did not fulfil eligibility criteria, the most common reasons were New York Heart Association functional class I (35.3%) and B\u2010type natriuretic peptide level of 100\u00a0pg\/\n ml<\/jats:styled-content>\n or lower (22.2%). Compared with patients in the\n PARADIGM<\/jats:styled-content>\n \u2010\n HF<\/jats:styled-content>\n trial,\n VAGLAHS<\/jats:styled-content>\n patients were older (70.4 vs 63.8\u00a0yrs) and more likely to be male (98.5% vs 79.0%), and a higher proportion had\n New York Heart Association<\/jats:styled-content>\n functional class\n III<\/jats:styled-content>\n symptoms (35.4% vs 23.1%). Of the 965 patients with\n HF<\/jats:styled-content>\n r\n EF<\/jats:styled-content>\n , 34 (3.5%) had an active sacubitril\/valsartan prescription as of November 1, 2017, of whom 27 (79.4%) did not meet criteria.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Whereas 27% of patients with\n HF<\/jats:styled-content>\n r\n EF<\/jats:styled-content>\n were eligible to initiate sacubitril\/valsartan, only 3.5% of these patients were prescribed the medication. Although sacubitril\/valsartan reduced morbidity and mortality in clinical trials, it remains underused within this\n VA<\/jats:styled-content>\n healthcare system. This analysis provides important insights into the\n VA<\/jats:styled-content>\n and other healthcare systems regarding the opportunity for optimizing guideline\u2010directed\n HF<\/jats:styled-content>\n therapy.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/phar.2328","type":"journal-article","created":{"date-parts":[[2019,9,9]],"date-time":"2019-09-09T12:36:32Z","timestamp":1568032592000},"page":"1053-1059","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Evaluation of Patients with Heart Failure to Determine Eligibility for Treatment with Sacubitril\/Valsartan: Insights from a Veterans Administration Healthcare System"],"prefix":"10.1002","volume":"39","author":[{"given":"Jamie","family":"Han","sequence":"first","affiliation":[{"name":"Veterans Affairs Greater Los Angeles Healthcare System Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Chung","sequence":"additional","affiliation":[{"name":"Veterans Affairs Greater Los Angeles Healthcare System Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quyen L.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Veterans Affairs Greater Los Angeles Healthcare System Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Freny Vaghaiwalla","family":"Mody","sequence":"additional","affiliation":[{"name":"Veterans Affairs Greater Los Angeles Healthcare System Los Angeles California"},{"name":"Division of Cardiology University of California, Los Angeles Los Angeles California"},{"name":"David Geffen School of Medicine University of California, Los Angeles Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5274-7251","authenticated-orcid":false,"given":"Cynthia A.","family":"Jackevicius","sequence":"additional","affiliation":[{"name":"Veterans Affairs Greater Los Angeles Healthcare System Los Angeles California"},{"name":"Department of Pharmacy Practice and Administration Western University of Health Sciences Pomona California"},{"name":"Institute for Clinical Evaluative Sciences University of Toronto Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,10,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2015.07.004"},{"key":"e_1_2_6_3_1","first-page":"e240","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines","volume":"128","author":"Yancy CW","year":"2013","journal-title":"Circulation"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.05.011"},{"key":"e_1_2_6_5_1","unstructured":"Entresto[package insert].East Hanover NJ:Novartis;2015."},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409077"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2017.04.014"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2016.12.018"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.117.004302"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.118.005400"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2016.1724"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2014.08.007"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.788"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.12251"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10557-019-06873-1"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(97)00012-0"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.86.2.431"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2006.089656"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.04.070"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.027773"},{"key":"e_1_2_6_21_1","unstructured":"Lexicomp Online\u00ae Lexi\u2010Drugs\u00ae.Hudson OH:Lexi\u2010Comp Inc. 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