{"doi":"10.1161/jaha.122.028278","title":"Deciding Whether to Take Sacubitril/Valsartan: How Cardiologists and Patients Discuss Out‐of‐Pocket Costs","abstract":"Background Out-of-pocket costs have significant implications for patients with heart failure and should ideally be incorporated into shared decision-making for clinical care. High out-of-pocket cost is one potential reason for the slow uptake of newer guideline-directed medical therapies for heart failure with reduced ejection fraction. This study aims to characterize patient-cardiologist discussions involving out-of-pocket costs associated with sacubitril/valsartan during the early postapproval period. Methods and Results We conducted content analysis on 222 deidentified transcripts of audio-recorded outpatient encounters taking place between 2015 and 2018 in which cardiologists (n=16) and their patients discussed whether to initiate, continue, or discontinue sacubitril/valsartan. In the 222 included encounters, 100 (45%) contained discussions about cost. Cost was discussed in a variety of contexts: when sacubitril/valsartan was initiated, not initiated, continued, and discontinued. Of the 97 cost conversations analyzed, the majority involved isolated discussions about insurance coverage (64/97 encounters; 66%) and few addressed specific out-of-pocket costs or affordability (28/97 encounters; 29%). Discussion of free samples of sacubitril/valsartan was common (52/97 encounters; 54%), often with no discussion of a longer-term plan for addressing cost. Conclusions Although cost conversations were somewhat common in patient-cardiologist encounters in which sacubitril/valsartan was discussed, these conversations were generally superficial, rarely addressing affordability or cost-value judgments. Cardiologists frequently provided patients with a course of free sacubitril/valsartan samples without a plan to address the cost after the samples ran out.","journal":"Journal of the American Heart Association","year":2023,"id":372460,"datarank":0.26876392038420827,"base_score":1.791759469228055,"endowment":1.791759469228055,"self_citation_contribution":0.26876392038420827,"citation_network_contribution":0.0,"self_endowment_contribution":0.26876392038420827,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":5,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9523,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":419973,"name":"Dennis Akrobetu","orcid":"0000-0002-7004-2359","position":1,"is_corresponding":false},{"id":331189,"name":"Neal W. Dickert","orcid":"0000-0003-4415-3861","position":2,"is_corresponding":false},{"id":820393,"name":"Thuy‐Vi V. Nguyen","orcid":"0000-0002-4985-4950","position":3,"is_corresponding":false},{"id":904076,"name":"J. Kelly Davis","orcid":"0000-0002-9586-923X","position":4,"is_corresponding":false},{"id":1133088,"name":"Ada Campagna","orcid":null,"position":5,"is_corresponding":false},{"id":381949,"name":"Andrea R. Mitchell","orcid":null,"position":6,"is_corresponding":false},{"id":1132786,"name":"Anu Sharma","orcid":"0000-0002-0778-7593","position":7,"is_corresponding":false},{"id":381950,"name":"Candace D. Speight","orcid":null,"position":8,"is_corresponding":false},{"id":719295,"name":"Mary Carol Barks","orcid":"0000-0002-3060-5524","position":9,"is_corresponding":false},{"id":1051467,"name":"Samantha Farley","orcid":null,"position":10,"is_corresponding":false},{"id":1132787,"name":"Sophia Gutterman","orcid":"0000-0002-6437-1818","position":11,"is_corresponding":false},{"id":340665,"name":"Taruni S. Santanam","orcid":null,"position":12,"is_corresponding":false},{"id":415261,"name":"Peter A. Ubel","orcid":"0000-0001-8218-519X","position":13,"is_corresponding":false},{"id":972050,"name":"Birju Rao","orcid":"0000-0002-7593-8533","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:15:54.000926Z","pmid":"36974764","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}