{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:42:19Z","timestamp":1777419739477,"version":"3.51.4"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,10,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Sacubitril\/valsartan, a first\u2010in\u2010class angiotensin receptor neprilysin inhibitor, received US Food and Drug Administration approval in 2015 for heart failure with reduced ejection fraction (HFrEF). Our objective was to describe the sacubitril\/valsartan initiation rate, associated characteristics, and 6\u2010month follow\u2010up dosing among veterans with HFrEF who are renin\u2010angiotensin\u2010aldosterone system inhibitor (RAASi) na\u00efve.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Retrospective cohort study of veterans with HFrEF who are RAASi na\u00efve defined as left ventricular ejection fraction (LVEF) \u226440%; \u22651 in\/outpatient heart failure visit, first RAASi (sacubitril\/valsartan, angiotensin\u2010converting enzyme inhibitor [ACEI]), or angiotensin\u2010II receptor blocker [ARB]) fill from July 2015 to June 2019. Characteristics associated with sacubitril\/valsartan initiation were identified using Poisson regression models. From July 2015 to June 2019, we identified 3458 sacubitril\/valsartan and 29\u00a0367 ACEI or ARB initiators among veterans with HFrEF who are RAASi na\u00efve. Sacubitril\/valsartan initiation increased from 0% to 26.5%. Sacubitril\/valsartan (versus ACEI or ARB) initiators were less likely to have histories of stroke, myocardial infarction, or hypertension and more likely to be older and have diabetes mellitus and lower LVEF. At 6\u2010month follow\u2010up, the prevalence of \u226550% target daily dose for sacubitril\/valsartan, ACEI, and ARB initiators was 23.5%, 43.2%, and 47.1%, respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Sacubitril\/valsartan initiation for HFrEF in the Veterans Administration increased in the 4 years immediately following Food and Drug Administration approval. Sacubitril\/valsartan (versus ACEI or ARB) initiators had fewer baseline cardiovascular comorbidities and the lowest proportion on \u226550% target daily dose at 6\u2010month follow\u2010up. Identifying the reasons for lower follow\u2010up dosing of sacubitril\/valsartan could support guideline recommendations and quality improvement strategies for patients with HFrEF.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.020474","type":"journal-article","created":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T23:10:59Z","timestamp":1633648259000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Sacubitril\/Valsartan Initiation Among Veterans Who Are Renin\u2010Angiotensin\u2010Aldosterone System Inhibitor Na\u00efve With Heart Failure and Reduced Ejection Fraction"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4510-9758","authenticated-orcid":false,"given":"April F.","family":"Mohanty","sequence":"first","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5429-3852","authenticated-orcid":false,"given":"Emily B.","family":"Levitan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Alabama at Birmingham School of Public Health Birmingham AL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6783-7951","authenticated-orcid":false,"given":"Jordan B.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT"},{"name":"Institute for Health Research Kaiser Permanente Colorado Aurora CO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A.","family":"Dodson","sequence":"additional","affiliation":[{"name":"Leon H. Charney Division of Cardiology Department of Medicine New York University School of Medicine New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orly","family":"Vardeny","sequence":"additional","affiliation":[{"name":"University of Minnesota Medical School Minneapolis MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5242-3975","authenticated-orcid":false,"given":"James","family":"Cook","sequence":"additional","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9257-8843","authenticated-orcid":false,"given":"Jennifer S.","family":"Herrick","sequence":"additional","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"He","sequence":"additional","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8717-5975","authenticated-orcid":false,"given":"Olga V.","family":"Patterson","sequence":"additional","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5176-5447","authenticated-orcid":false,"given":"Patrick R.","family":"Alba","sequence":"additional","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia A.","family":"Russo","sequence":"additional","affiliation":[{"name":"US Health Economics &amp; Outcomes Research Novartis Pharmaceuticals CorporationEast Hanover NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1807-3465","authenticated-orcid":false,"given":"Engels N.","family":"Obi","sequence":"additional","affiliation":[{"name":"US Health Economics &amp; Outcomes Research Novartis Pharmaceuticals CorporationEast Hanover NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle E.","family":"Choi","sequence":"additional","affiliation":[{"name":"Now with Sanofi Bridgewater NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2427-9504","authenticated-orcid":false,"given":"James C.","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2259-5039","authenticated-orcid":false,"given":"Adam P.","family":"Bress","sequence":"additional","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"},{"name":"Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000509"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2016.12.018"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.117.004302"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.118.005400"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.11.011"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000160417.39497.a9"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-017-0580-8"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-018-0710-4"},{"key":"e_1_3_2_10_2","unstructured":"VA Pharmacy Benefits Management Services . 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