Mohanty AF, Levitan EB, King JB, et al. - Findings showed an increase in sacubitril/valsartan (a first‐in‐class angiotensin receptor neprilysin inhibitor) initiation for heart failure with reduced ejection fraction (HFrEF) in the Veterans Administration in the 4 years immediately after Food and Drug Administration approval. Fewer baseline cardiovascular comorbidities and the lowest proportion on ≥50% target daily dose at 6‐month follow‐up were the findings among sacubitril/valsartan (vs angiotensin‐converting enzyme inhibitor [ACEI] or angiotensin‐II receptor blocker [ARB]) initiators.

• This is a retrospective cohort study of veterans with HFrEF who were renin‐angiotensin‐aldosterone system inhibitor naïve; 3,458 sacubitril/valsartan and 29,367 ACEI or ARB initiators were found from July 2015 to June 2019.

• An increment in sacubitril/valsartan initiation, from 0% to 26.5%, was evident.

• Less probability of having histories of stroke, myocardial infarction, or hypertension and more likelihood to be older and have diabetes mellitus and lower left ventricular ejection fraction were observed in sacubitril/valsartan (vs ACEI or ARB) initiators.

• Prevalence of ≥50% target daily dose for sacubitril/valsartan, ACEI, and ARB initiators, at 6‐month follow‐up, was reported to be 23.5%, 43.2%, and 47.1%, respectively.