Practical guidance on the use of sacubitril/valsartan for heart failure

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Sacubitril/valsartan is a novel angiotensin receptor-neprilysin inhibitor (ARNI) recommended for heart failure with reduced ejection fraction (HFrEF).
• Despite proven benefits in reducing morbidity and mortality, ARNI therapy uptake remains suboptimal in eligible HFrEF patients.

Purpose of the Study:

• To provide a comprehensive overview of ARNI therapy.
• To propose strategies for enhancing the clinical implementation of sacubitril/valsartan.
• To offer evidence-based guidance for clinicians on using sacubitril/valsartan in HFrEF patients.

Main Methods:

• Review of existing clinical practice guidelines and evidence on ARNI therapy.
• Analysis of barriers to sacubitril/valsartan prescription, including practitioner unfamiliarity, safety concerns, and reimbursement issues.
• Proposal of practical strategies for adverse event management and patient concern resolution.
• Introduction of a treatment sequence scheme for gradual ARNI initiation.

Main Results:

• ARNI therapy demonstrates significant benefits over standard care for HFrEF.
• Key barriers to ARNI prescription include lack of clinician familiarity, safety apprehensions, and reimbursement challenges.
• Effective implementation strategies can improve ARNI utilization and reduce the overall burden of heart failure.

Conclusions:

• Optimizing the implementation of sacubitril/valsartan is crucial for improving outcomes in HFrEF patients.
• Addressing practical barriers and providing clear clinical guidance can enhance ARNI therapy adoption.
• A structured approach to ARNI initiation, including managing side effects, is essential for successful patient management.