What condition has been shown to have more hospitalizations in the U.S. in the past years than pneumonia or heart attacks? It’s heart failure (HF).
HF is one of the leading causes of hospitalization, resulting in about 900,000 hospitalizations in the U.S. annually. That’s approximately two hospitalizations every minute. HF is a chronic, progressive condition that typically worsens over time. Approximately 40% of patients may be hospitalized four or more times in their lifetime.
HF signs and symptoms include shortness of breath or swelling of the feet, legs, and ankles. When some symptoms, like shortness of breath, are severe, patients may be hospitalized. It can result in missing work and other burdens. The experience may be terrifying and cause a great deal of stress for patients, their families, and caregivers.
For all too many living with HF, hospitalizations are a recurring part of their life. They are a hallmark of disease progression. While a visit to the hospital may provide symptom relief, the experience can have a serious impact on patients and their caregivers: about one in four patients may be readmitted — with the most common reason being HF — and up to 10% may die within 30 days of discharge.
In certain populations, ~6 days has been the estimated average length of stay, making the burden of HF costly for the patient and caregiver, and also for society. HF presents a major, growing health-economic burden that exceeds $30 billion in the U.S., which accounts for direct and indirect costs. As the population ages, the burden of HF and related hospitalizations increases.
However, many hospitalizations may be avoidable, and there are options for patients and their health care providers.
There are two main types of HF; one is heart failure with reduced ejection fraction (HFrEF), which causes half of all HF hospitalizations. Treatment options for HFrEF are available to reduce hospitalizations; but according to a recent analysis, they may be underutilized.
For example, ENTRESTO® (sacubitril/valsartan), a first-choice HF medication recommended by the joint ACCF/AHA/HFSA guidelines, was proven superior to enalapril at keeping people alive and out of the hospital longer.
Following hospitalization, heart failure patients enter a vulnerable period, so optimizing care in the hospital is important. While they have limitations, new data show that ENTRESTO can be started in appropriate stabilized HF patients in the hospital rather than waiting until after discharge. There is now evidence in both the inpatient and outpatient settings supporting the use of ENTRESTO.
ENTRESTO is indicated for the treatment of patients with chronic HF (NYHA Class II-IV) and HFrEF to reduce the risk of cardiovascular death and HF hospitalization.
According to recent analysis, which looked at data from a large registry of HFrEF patients, major gaps exist in use of guideline-recommended medications for HFrEF, like ENTRESTO. Another set of data suggests optimizing guideline-recommended medications may prevent up to tens of thousands of deaths from HF.
So, what can patients and their health care providers do?
Patients and their health care providers can play an important role in HF care by utilizing guideline-recommended medications such as ENTRESTO. Guideline-recommended care for HF is a key to reducing hospitalizations and the burden on patients, caregivers, and the health care system.
What is ENTRESTO?
ENTRESTO is a prescription medicine used to reduce the risk of death and hospitalization in adults with long-lasting (chronic) heart failure. ENTRESTO is usually used with other heart failure therapies, in place of an angiotensin-converting enzyme (ACE) inhibitor or other angiotensin II receptor blocker (ARB) therapy.
IMPORTANT SAFETY INFORMATION
What is the most important information I should know about ENTRESTO?
ENTRESTO can harm or cause death to your unborn baby. Talk to your doctor about other ways to treat heart failure if you plan to become pregnant. If you get pregnant while taking ENTRESTO, tell your doctor right away.
Who should not take ENTRESTO?
Do not take ENTRESTO if you
- are allergic to sacubitril or valsartan or any of the ingredients in ENTRESTO
- have had an allergic reaction including swelling of your face, lips, tongue, throat (angioedema) or trouble breathing while taking a type of medicine called an ACE inhibitor or ARB
- take an ACE inhibitor medicine. Do not take ENTRESTO for at least 36 hours before or after you take an ACE inhibitor medicine. Talk with your doctor or pharmacist before taking ENTRESTO if you are not sure if you take an ACE inhibitor medicine
- have diabetes and take a medicine that contains aliskiren
What should I tell my doctor before taking ENTRESTO?
Before you take ENTRESTO, tell your doctor about all of your medical conditions, including if you have kidney or liver problems or a history of hereditary angioedema; are pregnant or plan to become pregnant; are breastfeeding or plan to breastfeed. You should either take ENTRESTO or breastfeed. You should not do both.
Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your doctor if you take potassium supplements or a salt substitute; nonsteroidal anti-inflammatory drugs (NSAIDs); lithium; or other medicines for high blood pressure or heart problems such as an ACE inhibitor, ARB, or aliskiren.
What are the possible side effects of ENTRESTO?
ENTRESTO may cause serious side effects including:
- angioedema that may cause trouble breathing and death. Get emergency medical help right away if you have symptoms of angioedema or trouble breathing. Do not take ENTRESTO again if you have had angioedema while taking ENTRESTO. People who are Black or who have had angioedema and take ENTRESTO may have a higher risk of having angioedema
- low blood pressure (hypotension). Call your doctor if you become dizzy or lightheaded, or you develop extreme fatigue
- kidney problems
- increased amount of potassium in your blood
The most common side effects were low blood pressure, high potassium, cough, dizziness, and kidney problems.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
This information is not comprehensive. Please see full Prescribing Information, including Boxed WARNING, and Patient Prescribing Information.
– McDermott K, Elixhauser A, Sun R. Trends in hospital inpatient stays in the United Sates, 2005-2014. HCUP. 2017; Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/statbriefs/sb225-Inpatient-US-Stays-Trends.pdf.
– Weir L, Pfuntner A, Maeda J, et al. HCUP facts and figures: statistics on hospital-based care in the United States, 2009. Rockville, MD: Agency for Healthcare Research and Quality, 2011. https://www.ncbi.nlm.nih.gov/books/NBK91984/ (link is external). Accessed March 1, 2019.
– Benjamin E, Muntner P, Alonso A, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139:e56–e66. doi: https://doi.org/10.1161/CIR.0000000000000659
– Fauci A, Longo D. Disorders of the Heart. Harrison’s ‘Principles of Internal Medicine. 17th 2008; 4:1442-55.
– American Heart Association. What is Heart Failure? Website. http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/What-is-Heart-Failure_UCM_002044_Article.jsp#.WvB9T6iPKyJ. Updated March 7, 2018. Accessed May 10, 2019.
– Yancy C, Jessup M, Bozkurt B, et al. 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. Circulation. 2013;128:e240-e327. doi: 10.1016/j.jacc.2013.05.019.
– Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93:1137-46. doi: 10.1136/hrt.2003.025270.
– Mayo Clinic Heart Failure website. https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148. Published August 18, 2015. Accessed April 30, 2019.
– American Heart Association. The Impact of Heart Failure in America Today. Rise Above Heart Failure. 2015.
– Gheorghiade M, De Luca L, Fonarow GC, et al. Pathophysiologic targets in the early phase of acute heart failure syndromes. Am J Cardiol. 2005;96(6A):11G-17G.
– Dharmarajan K, Hsieh A, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309(4):355-363. doi:10.1001/jama.2012.216476.
– Bueno H, Ross J, Wang Y, et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure: 1993-2008. JAMA. 2010;303(21):2141-2147. doi: 10.1001/jama.2010.748.
– Ponikowski P, Anker S, AlHabib K, et al. Heart failure: preventing disease and death worldwide. ESC Heart Failure. 2014;1:4–25. doi:10.1002/ehf2.12005.
– Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6:606-619.
– Yancy C, Jessup M, Butler J, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137-161. doi: 10.1161/CIR.0000000000000509.
– Greene SJ, Butler J, Albert NM, et al. Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry. J Am Coll Cardiol. 2018;72(4): 351–366. doi: 10.1016/j.jacc.2018.04.070
– Velazquez EJ, Morrow DA, DeVore, AD, et al. Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. N Engl J Med. 2019;380:539-548 doi: 10.1056/NEJMoa1812851.
– McMurray JJV, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993-1004. doi: 10.1056/NEJMoa1409077.
– ENTRESTO [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; October 2019.
– Wachter R, Senni M, Belohlavek J, et al. Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. Eur J Heart Fail. 2019;21(8):998-1007. doi: 10.1002/ejhf.1498.
– Fonarow G, Hernandez A, Solomon S, et al. Potential Mortality Reduction With Optimal Implementation of Angiotensin Receptor Neprilysin Inhibitor Therapy in Heart Failure. JAMA Cardiol. 2016;1(6):714-717. doi:10.1001/jamacardio.2016.1724
– Hollenberg S, Warner Stevenson L, Ahmad T, et al. ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2019;74:15. doi: 10.1016/j.jacc.2019.08.00.