Feasibility of sacubitril/valsartan initiation early after acute decompensated heart failure

Despite significant diagnostic and therapeutic advances, heart failure (HF) is linked with high mortality and morbidity. Hospitalization for decompensated HF is still the most common cause of hospitalization in adults. What is more, a particularly high risk of hospitalization (even up to 50% of patients) is observed within a few months after a previous HF hospitalization. Sacubitril/valsartan, a first-in-class drug, contains a neprilysin inhibitor (sacubitril) and an angiotensin II receptor blocker (valsartan). In PARADIGM-HF trial investigators showed, that sacubitril/valsartan significantly reduced primary endpoint combined with cardiovascular death or HF hospitalization in patients with chronic, symptomatic HF (New York Heart Association class II-IV) with reduced ejection fraction (left ventricular ejection fraction [LVEF] ≤ 35-40%). Recently, results of the PIONEER-HF trial, which included HF patients with LVEF ≤ 40% who were hospitalized for acute decompensated HF were also published. The study proved that early, in-hospital, implementation of sacubitril/valsartan in these patients resulted in a substantially greater reduction of N-terminal prohormone B-type natriuretic peptide concentration and a lower rate of HF rehospitalizations with similar safety profile for enalapril.