The Impact of the 2022 Heart Failure Guidelines on National and Hawaii Prescribing Trends of Sacubitril/Valsartan (from 2015-2023)

Abstract

Purpose: Sacubitril/valsartan was approved in 2015 and is now recommended as a first-line guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF), preferred over angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor II blockers (ARBs) in the 2022 American Heart Association/American Academy of Cardiology (AHA/ACC) Heart Failure Guidelines. In contrast to the 2016 guidelines, where sacubitril/valsartan was regarded as equivalent with ACEi & ARBs. The objective of this study was to evaluate national and Hawaii prescribing trends of sacubitril/valsartan in response to the 2022 guideline update.

Methods: This was a retrospective evaluative study that utilized data from the Centers of Medicare and Medicaid Services public database from 2015 to 2023. Annual sacubitril/valsartan claims and total annual beneficiaries of Medicare and Medicaid services were collected. Territories and regions outside of the United States were excluded. Prescribing rates per year were calculated by dividing the total number of sacubitril/valsartan claims by all beneficiaries per 1,000 for each year. The estimated national average was determined by averaging all states’ claims and total beneficiaries per year. Yearly changes in sacubitril/valsartan claims was calculated by taking the difference in prescribing rates per 10,000 beneficiaries per year. This data was assessed using line graphs for visual examination and comparison.

Results: Since 2015, there has been an increase in sacubitril/valsartan use each year both nationally and in Hawaii with a general trend upward showing increased prescribing rates. National trends and Hawaii trends followed a similar pattern, with slightly more claims per 1,000 beneficiaries nationally. The largest change in claims occurred in 2022, where for every 10,000 beneficiaries, there were 10.48 more sacubitril/valsartan claims for Hawaii and 10.45 for the estimated national average. The smallest change in claims was in 2015 with 0.09 more claims per 10,000 for Hawaii and 0.19 more claims per 10,000 nationally.

Conclusion: Since the approval of sacubitril/valsartan in 2015, the prescription rate trends has been steadily increasing each year. A notable peak in sacubitril/valsartan claims occurred both in Hawaii and nationally after the 2022 guideline update. Limitations of this study include the lack of available data after 2023 and potential confounders such as cost and formulary changes. Future studies should evaluate a longer time period (after 2022) and assess the impact of the recently released generic formulation of sacubitril/valsartan in July 2025.