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Sacubitril–Valsartan in Heart Failure: Why Are More Physicians Not Prescribing It?Sacubitril–Valsartan in Heart Failure ONLINE FIRST

Milton Packer, MD; W. Mark Armstrong, MD; Joseph M. Rothstein, MD; and Michael Emmett, MD
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 30 August 2016.

From Baylor Heart and Vascular Institute and the Department of Medicine, Baylor University Medical Center, Dallas, Texas.

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1932.

Requests for Single Reprints: Milton Packer, MD, Baylor Heart and Vascular Institute, Baylor University Medical Center, 621 North Hall Street, Dallas, TX 75226; e-mail, milton.packer@baylorhealth.edu.

Current Author Addresses: Dr. Packer: Baylor Heart and Vascular Institute, Baylor University Medical Center, 621 North Hall Street, Dallas, TX 75226.

Drs. Armstrong, Rothstein, and Emmett: Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246.

Ann Intern Med. Published online 30 August 2016 doi:10.7326/M16-1932
© 2016 American College of Physicians
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Sandhu and colleagues' article supports the cost-effectiveness of sacubitril–valsartan in the treatment of heart failure. This analysis and others have reported favorable results associated with switching patients from conventional renin–angiotensin inhibitors to sacubitril–valsartan. The editorialists review the evidence for the benefits of this newer drug and explore reasons for what they believe is the slow adoption of sacubitril–valsartan in the management of heart failure.

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We should step up to address the real problems!
Posted on August 30, 2016
Earl W. Ferguson, MD, PhD, FACC, FACPM, FACP
Ridgecrest Regional Hospital, Ridgecrest, CA
Conflict of Interest: None Declared

As a former academician and healthcare executive for 20 years who has been practicing medicine in a remote, under served area for 20 years, I have a different perspective. In the 40 years since I completed my training, medicine has markedly changed. It has become increasingly bureaucratic and far too expensive because of governmental,insurance company and other requirements. It is no longer the medicine I learned and enjoyed in the earlier part of my career, and still love and practice because I bailed out of the bureaucracy. The fault is our profession that has lost its independence because we did not take an active enough role in shaping our future. We should have done better, but we didn't meet the challenge. We've got to cut the bureaucracy and costs. Simpler, less expensive alternatives and better coordinated care to really transform American medicine is the only answer. Why spend so much for excessively expensive medications?

Earl W. Ferguson, MD, PhD, FACC, FACPM, FACP


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