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Prospective Monitoring of Angiotensin Receptor Neprilysin Inhibitor in Older Adults With Heart Failure and Frailty

Conditions
Heart Failure, Systolic
Frailty
Interventions
Registration Number
NCT04743063
Lead Sponsor
Brigham and Women's Hospital
Brief Summary

The objective of this study is to establish a near-real-time prospective monitoring program in Medicare, Optum and MarketScan Research data to evaluate the benefit of new cardiovascular disease (CVD) drugs for older adults with frailty. Prospective monitoring program seeks to find early effectiveness and safety signals of new drugs by updating the analysis at regular intervals as new Medicare data become available. This study specifically aims to emulate a prospective surveillance of the effectiveness and safety of Angiotensin Receptor Neprilysin Inhibitor(ARNI) vs. a comparator, Angiotensin II Receptor Blockers (ARBs), in older adults with Heart Failure with Reduced Ejection Fraction (HFrEF) and different frailty status. This program will be enhanced by incorporating a novel claims-based frailty index, which has been shown useful in assessing how the benefits and harms of drug therapy vary by frailty.

Detailed Description

Data sources of use for this study are: Medicare Database, Optum Database, and MarketScan Research Database. All data from years 2014-2020 will be included in the study.

This study follows a sequential cohort monitoring design. The monitoring analysis will include 1) retrospective analysis of available data (2015-2017) at the time of first analysis (January 2021) and 2) prospective analysis of new data (2018-2020) as they become available to the researchers. Within each database, we will emulate biannual updating of data by creating a propensity score (PS)-matched cohort of new users every 6-month interval, beginning on the first marketing of ARNI (July 7, 2015-December 31, 2015, and 6-month intervals afterwards). Each sequential cohort will be followed for development of the outcomes of interest. Outcome analysis will be performed at a pre-specified 6-month interval (prospective analysis). The surveillance will be performed by frailty status (frail vs non-frail) at the time of drug initiation. The results from each database will be pooled using fixed-effects meta-analysis (assuming low heterogeneity across the databases).

Recruitment & Eligibility

Status
UNKNOWN
Sex
All
Target Recruitment
40000
Inclusion Criteria
  • Continuous enrollment for medical and drug insurance (e.g., Medicare Part A, B, and D) in [-365, 0] days

  • Diagnosis of Heart Failure either two outpatient diagnosis or one inpatient diagnosis in [-365, 0] days

  • Reduced Ejection Fraction < 45% identified using a validated claims-based algorithm in [-365, 0] days

    • Day 0 is the initiation date of the study drug.
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Exclusion Criteria
  • No prior use of Angiotensin receptor neprilysin inhibitor or angiotensin II receptor blocker in [-365, -1] days
  • No recent HF hospitalization, defined as HF diagnosis (defined in attached protocol) in the primary position in the inpatient dataset in [-60, 0] days
  • No recent nursing facility stay (defined in attached protocol) for [-60, 0] days
  • Age < 65 years
  • Exposure to both drugs on day 0
  • Contraindication to either drug (exclusion assessment window: [-60, 0] days, unless specified otherwise; algorithms specified in attached protocol)

Note: If a patient meets the above-mentioned eligibility criteria more than once, only the first record will be included.

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Study & Design

Study Type
OBSERVATIONAL
Study Design
Not specified
Arm && Interventions
GroupInterventionDescription
New users of angiotensin II receptor blockersAngiotensin II Receptor Blockers-
New users of angiotensin receptor neprilysin inhibitorsacubitril/valsartan-
Primary Outcome Measures
NameTimeMethod
Number of patients with composite events of death or heart failure hospitalizationJuly 2015 - December 2020

All-cause mortality OR heart failure hospitalization

Number of patients with composite serious adverse eventsJuly 2015 - December 2020

Hypotension OR acute kidney injury/acute kidney failure OR hyperkalemia OR angioedema

Secondary Outcome Measures
NameTimeMethod
Number of patients with heart failure hospitalizationJuly 2015 - December 2020

Heart failure hospitalization is defined as any hospitalization with relevant diagnosis codes in the primary position.

Number of patients with all-cause mortalityJuly 2015 - December 2020

All-cause mortality is defined by the National Death Index file or vital status information in the claims dataset.

Number of patients with hypotensionJuly 2015 - December 2020

Hypotension is defined as any hospitalization or Emergency Department visit with relevant diagnosis codes in the primary position.

Number of patients with hyperkalemiaJuly 2015 - December 2020

Hyperkalemia is defined as any hospitalization or Emergency Department visit with relevant diagnosis codes in the primary position.

Number of patients with acute kidney injury/acute kidney failureJuly 2015 - December 2020

Acute kidney injury/Acute kidney failure is defined as any hospitalization or Emergency Department visit with relevant diagnosis codes in the primary position.

Number of patients with angioedemaJuly 2015 - December 2020

Angioedema is defined as any hospitalization or Emergency Department visit with relevant diagnosis codes in the primary position.

Trial Locations

Locations (1)

Brigham And Women's Hospital

🇺🇸

Boston, Massachusetts, United States

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