Imagine you are caring for a patient with a lethal disease. She has responded well and has few symptoms, but the disease is still present and will worsen in the future. Suddenly, a new drug becomes available that can extend life by 1 to 2 years more than you can achieve with the current therapy. What do you do?

Oncologists would adopt the new drug as the standard of care in a heartbeat, but US physicians who treat patients with heart failure often do little. Heart failure is a fatal disorder, and current drugs achieve only a brief clinical remission. Two years ago, sacubitril/valsartan was shown to be superior to a conventional inhibitor of the renin-angiotensin system in reducing the risk of cardiovascular death,¹ and it received expedited US Food and Drug Administration approval for treatment of chronic heart failure. Owing to cost, third-party payors discouraged the use of the drug by requiring high patient copays and administrative preapprovals. Oncologists are accustomed to overcoming these distractions, but other physicians are not. Consequently, uptake of sacubitril/valsartan by US practitioners has been slow.