Early impact of guideline publication on angiotensin-receptor neprilysin inhibitor use among patients hospitalized for heart failure

Nancy Luo, Nicholas G. Ballew, Emily C. O'Brien, Melissa A. Greiner, Pamela N. Peterson, Bradley G. Hammill, N. Chantelle Hardy, Warren K. Laskey, Paul A. Heidenreich, Chun Lan Chang, Adrian F. Hernandez, Lesley H. Curtis, Robert J. Mentz, Gregg C. Fonarow

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: On May 20, 2016, US professional organizations in cardiology published joint treatment guidelines recommending the use of angiotensin-receptor neprilysin inhibitor (ARNI) for eligible patients with heart failure with reduced ejection fraction (HFrEF). Using data from the Get With The Guidelines–Heart Failure registry, we evaluated the early impact of this update on temporal trends in ARNI prescription. Methods: We analyzed patients with HFrEF who were eligible for ARNI prescription (EF ≤40%, no contraindications) and hospitalized from February 20, 2016, through August 19, 2016—allowing for 13 weeks before and after guideline publication. We quantified trends in ARNI use associated with guidelines publication with an interrupted time-series design using logistic regression and accounting for correlations within hospitals using general estimating equation methods. Results: Of 7,200 eligible patient hospitalizations, 51.9% were discharged in the period directly preceding publication of the guidelines, and 48.1% were discharged after. Odds ratios of ARNI prescription at discharge were significantly higher in the postguideline period compared with the preguideline period in adjusted models (adjusted odds ratio 1.29, 95% CI 1.06-1.57, P =.01). However, there was no significant interaction between observed and expected ARNI use after guideline publication (P interaction =.14). Results were consistent using a 6-month before and after time frame. Conclusions: The model suggested a small increase in ARNI use in HF patients being discharged from the hospital immediately after guideline release. However, the publication of national guidelines recommending ARNI use seemed to have little influence on the adoption of this evidence-based medication in the first 3 to 6 months.

Original languageEnglish (US)
Pages (from-to)134-140
Number of pages7
JournalAmerican heart journal
Volume200
DOIs
StatePublished - Jun 2018
Externally publishedYes

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Neprilysin
Angiotensin Receptors
Publications
Heart Failure
Guidelines
Prescriptions
Odds Ratio
Cardiology
General Hospitals
Registries
Hospitalization
Joints
Logistic Models

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Early impact of guideline publication on angiotensin-receptor neprilysin inhibitor use among patients hospitalized for heart failure. / Luo, Nancy; Ballew, Nicholas G.; O'Brien, Emily C.; Greiner, Melissa A.; Peterson, Pamela N.; Hammill, Bradley G.; Hardy, N. Chantelle; Laskey, Warren K.; Heidenreich, Paul A.; Chang, Chun Lan; Hernandez, Adrian F.; Curtis, Lesley H.; Mentz, Robert J.; Fonarow, Gregg C.

In: American heart journal, Vol. 200, 06.2018, p. 134-140.

Research output: Contribution to journalArticle

Luo, N, Ballew, NG, O'Brien, EC, Greiner, MA, Peterson, PN, Hammill, BG, Hardy, NC, Laskey, WK, Heidenreich, PA, Chang, CL, Hernandez, AF, Curtis, LH, Mentz, RJ & Fonarow, GC 2018, 'Early impact of guideline publication on angiotensin-receptor neprilysin inhibitor use among patients hospitalized for heart failure', American heart journal, vol. 200, pp. 134-140. https://doi.org/10.1016/j.ahj.2018.01.009
Luo, Nancy ; Ballew, Nicholas G. ; O'Brien, Emily C. ; Greiner, Melissa A. ; Peterson, Pamela N. ; Hammill, Bradley G. ; Hardy, N. Chantelle ; Laskey, Warren K. ; Heidenreich, Paul A. ; Chang, Chun Lan ; Hernandez, Adrian F. ; Curtis, Lesley H. ; Mentz, Robert J. ; Fonarow, Gregg C. / Early impact of guideline publication on angiotensin-receptor neprilysin inhibitor use among patients hospitalized for heart failure. In: American heart journal. 2018 ; Vol. 200. pp. 134-140.
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abstract = "Background: On May 20, 2016, US professional organizations in cardiology published joint treatment guidelines recommending the use of angiotensin-receptor neprilysin inhibitor (ARNI) for eligible patients with heart failure with reduced ejection fraction (HFrEF). Using data from the Get With The Guidelines–Heart Failure registry, we evaluated the early impact of this update on temporal trends in ARNI prescription. Methods: We analyzed patients with HFrEF who were eligible for ARNI prescription (EF ≤40{\%}, no contraindications) and hospitalized from February 20, 2016, through August 19, 2016—allowing for 13 weeks before and after guideline publication. We quantified trends in ARNI use associated with guidelines publication with an interrupted time-series design using logistic regression and accounting for correlations within hospitals using general estimating equation methods. Results: Of 7,200 eligible patient hospitalizations, 51.9{\%} were discharged in the period directly preceding publication of the guidelines, and 48.1{\%} were discharged after. Odds ratios of ARNI prescription at discharge were significantly higher in the postguideline period compared with the preguideline period in adjusted models (adjusted odds ratio 1.29, 95{\%} CI 1.06-1.57, P =.01). However, there was no significant interaction between observed and expected ARNI use after guideline publication (P interaction =.14). Results were consistent using a 6-month before and after time frame. Conclusions: The model suggested a small increase in ARNI use in HF patients being discharged from the hospital immediately after guideline release. However, the publication of national guidelines recommending ARNI use seemed to have little influence on the adoption of this evidence-based medication in the first 3 to 6 months.",
author = "Nancy Luo and Ballew, {Nicholas G.} and O'Brien, {Emily C.} and Greiner, {Melissa A.} and Peterson, {Pamela N.} and Hammill, {Bradley G.} and Hardy, {N. Chantelle} and Laskey, {Warren K.} and Heidenreich, {Paul A.} and Chang, {Chun Lan} and Hernandez, {Adrian F.} and Curtis, {Lesley H.} and Mentz, {Robert J.} and Fonarow, {Gregg C.}",
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T1 - Early impact of guideline publication on angiotensin-receptor neprilysin inhibitor use among patients hospitalized for heart failure

AU - Luo, Nancy

AU - Ballew, Nicholas G.

AU - O'Brien, Emily C.

AU - Greiner, Melissa A.

AU - Peterson, Pamela N.

AU - Hammill, Bradley G.

AU - Hardy, N. Chantelle

AU - Laskey, Warren K.

AU - Heidenreich, Paul A.

AU - Chang, Chun Lan

AU - Hernandez, Adrian F.

AU - Curtis, Lesley H.

AU - Mentz, Robert J.

AU - Fonarow, Gregg C.

PY - 2018/6

Y1 - 2018/6

N2 - Background: On May 20, 2016, US professional organizations in cardiology published joint treatment guidelines recommending the use of angiotensin-receptor neprilysin inhibitor (ARNI) for eligible patients with heart failure with reduced ejection fraction (HFrEF). Using data from the Get With The Guidelines–Heart Failure registry, we evaluated the early impact of this update on temporal trends in ARNI prescription. Methods: We analyzed patients with HFrEF who were eligible for ARNI prescription (EF ≤40%, no contraindications) and hospitalized from February 20, 2016, through August 19, 2016—allowing for 13 weeks before and after guideline publication. We quantified trends in ARNI use associated with guidelines publication with an interrupted time-series design using logistic regression and accounting for correlations within hospitals using general estimating equation methods. Results: Of 7,200 eligible patient hospitalizations, 51.9% were discharged in the period directly preceding publication of the guidelines, and 48.1% were discharged after. Odds ratios of ARNI prescription at discharge were significantly higher in the postguideline period compared with the preguideline period in adjusted models (adjusted odds ratio 1.29, 95% CI 1.06-1.57, P =.01). However, there was no significant interaction between observed and expected ARNI use after guideline publication (P interaction =.14). Results were consistent using a 6-month before and after time frame. Conclusions: The model suggested a small increase in ARNI use in HF patients being discharged from the hospital immediately after guideline release. However, the publication of national guidelines recommending ARNI use seemed to have little influence on the adoption of this evidence-based medication in the first 3 to 6 months.

AB - Background: On May 20, 2016, US professional organizations in cardiology published joint treatment guidelines recommending the use of angiotensin-receptor neprilysin inhibitor (ARNI) for eligible patients with heart failure with reduced ejection fraction (HFrEF). Using data from the Get With The Guidelines–Heart Failure registry, we evaluated the early impact of this update on temporal trends in ARNI prescription. Methods: We analyzed patients with HFrEF who were eligible for ARNI prescription (EF ≤40%, no contraindications) and hospitalized from February 20, 2016, through August 19, 2016—allowing for 13 weeks before and after guideline publication. We quantified trends in ARNI use associated with guidelines publication with an interrupted time-series design using logistic regression and accounting for correlations within hospitals using general estimating equation methods. Results: Of 7,200 eligible patient hospitalizations, 51.9% were discharged in the period directly preceding publication of the guidelines, and 48.1% were discharged after. Odds ratios of ARNI prescription at discharge were significantly higher in the postguideline period compared with the preguideline period in adjusted models (adjusted odds ratio 1.29, 95% CI 1.06-1.57, P =.01). However, there was no significant interaction between observed and expected ARNI use after guideline publication (P interaction =.14). Results were consistent using a 6-month before and after time frame. Conclusions: The model suggested a small increase in ARNI use in HF patients being discharged from the hospital immediately after guideline release. However, the publication of national guidelines recommending ARNI use seemed to have little influence on the adoption of this evidence-based medication in the first 3 to 6 months.

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