Key result
Practicing in Asia linked to ~65% lower odds of non-labeled sacubitril-valsartan dosing for HF.
Why the study?
Optimizing GDMT is vital for heart failure management, but non-labeled dosing of sacubitril-valsartan is increasingly reported.
What are the global trends and predictors of non-labeled sacubitril-valsartan dosing among clinicians treating heart failure?
Cross-Sectional (n=1,829)
Yes
What are the global trends and predictors of non-labeled sacubitril-valsartan dosing among clinicians treating heart failure?
A global survey reveals that over 80% of clinicians use non-labeled dosing of sacubitril-valsartan in real-world heart failure management, highlighting a substantial gap between guideline recommendations and clinical practice.
Non-labeled sacubitril-valsartan dosing is prevalent globally; leaves open whether pharmacist presence or regional factors improve guideline alignment in heart failure.
BACKGROUND: Optimizing guideline-directed medical therapy (GDMT) remains vital for heart failure (HF) management. However, non-labeled dosing of sacubitril-valsartan is increasingly reported. OBJECTIVES: This global survey characterized real-world sacubitril-valsartan prescribing patterns and evaluated pharmacist involvement in HF teams. METHODS: The validated 26-item IKNOW-HF survey was disseminated globally to clinicians treating patients with HF. Participation was voluntary and anonymous. RESULTS: Out of 1,829 responses from 75 countries, 1,285 (70.3%) were complete, predominantly from cardiologists 1,031 (80.2%). Non-labeled sacubitril-valsartan dosing was reported by 1,107 (86.1%) respondents, heavily driven by general cardiologists 326 (90%) and clinicians in the low- and lower-middle-income countries 195 (96%). Predictors of non-labeled dosing included practicing in Asia [OR 0.347; 95% CI (0.214-0.563)] and having over 10 years of experience [OR 0.695; 95% CI (0.489-0.990)]. The presence of a cardiology pharmacist trended toward a fewer non-labeled prescriptions [OR 0.542; 95% CI (0.283-1.039), p-value 0.065], whereas management by HF specialist trended toward increased non-labeled usage [OR 1.443; 95% CI (0.981-2.122), p-value 0.063]. CONCLUSIONS: The IKNOW-HF survey reveals a substantial variation between guideline-recommended and real-world prescribing practices, with over 80% of responding clinicians utilizing non-labeled dosing. The higher prevalence among HF specialists likely reflect a pragmatic salvage strategy for advanced HF patients intolerant to standard target doses. These findings highlight the need for further education, pragmatic clinical trials evaluating real-world dosing outcomes, and broader integration of specialized pharmacists to optimize GDMT.
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Yaseen et al. (2026) conducted a cross-sectional in Heart failure (clinician prescribing practices) (n=1,829). Non-labeled sacubitril-valsartan dosing was evaluated on Non-labeled sacubitril-valsartan dosing (predictor: practicing in Asia) (OR 0.347, 95% CI 0.214-0.563). In a global survey, 86.1% of clinicians reported using non-labeled sacubitril-valsartan dosing for heart failure, with practicing in Asia predicting lower use (OR 0.347; 95% CI 0.214-0.563).
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