Perceived Barriers to Sacubitril/Valsartan Use in Patients with Heart Failure

Introduction Sacubitril-valsartan (sac/val) is approved and guideline-recommended for use in patients with heart failure with reduced ejection fraction (HFrEF). Clinical uptake of sac/val in clinical practice in the U.S. has been slow, despite a demonstrated mortality benefit and cost-effectiveness. Reasons as to why providers have not introduced sac/val more readily in patients with HFrEF have not been formally evaluated. We conducted a two-center survey to evaluate frequency of sac/val use, barriers to uptake, and strategies to overcome barriers. Methods We performed an email-based survey to cardiology faculty, fellows, pharmacists, and nurse practitioners within University of California Los Angeles (UCLA) and the Veterans Affairs West Los Angeles Medical Center (WLA VA). Participants were contacted by email on 2 occasions between October and December 2017, with 21 days to respond, and responses remained anonymous. Results Survey requests were sent to 142 individuals with 37 respondents, a 26.2% response rate. Most respondents were ages 31-40, male, physicians, and provided care to patients with heart failure on a weekly basis. The majority of respondents (64.8%) cited a current prescription rate of sac/val at 0-10% of their HFrEF patients. Most respondents believed that 26-50% of their patients were eligible to be prescribed sac/val. With respect to barriers, on a scale 1-5 (5=’significant barrier’), doubts about trial data had the lowest mean score (2.0), while affordability/out of pocket costs to patients was cited as the most significant barrier (3.8) (p Conclusions Physicians, pharmacists, and nurse practitioners frequently provide care to patients with HFrEF and they report many patients are eligible for sac/val, but a low percentage are prescribed this therapy. The greatest perceived barriers to uptake in this surveyed group are cost to payers/value to society and affordability/out of pocket cost to patients. Larger representative surveys will need to be performed to determine nationwide barriers and new strategies are needed to overcome these.