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Angiotensin Receptor-Neprilysin Inhibitor Therapy and Cardiac Remodeling in Heart Failure: Consensus Statement from

H K Chopra1, G S Wander2, Tiny Nair3

  • 1Senior Consultant, Department of Cardiology, Medanta Moolchand Heart Center, Delhi.

The Journal of the Association of Physicians of India
|June 25, 2023
PubMed

Insights

Angiotensin receptor-neprilysin inhibitor (ARNI) is underused in India for heart failure despite its benefits. Experts recommend early, effective ARNI dosing to improve cardiac reverse remodeling and patient outcomes.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Adverse cardiac remodeling, characterized by heart structure and function changes, is driven by myocardial stress and neurohormonal factors.
  • Guideline-directed medical therapy for heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI), beta-blockers, SGLT2 inhibitors, and MRAs.
  • ARNI demonstrates a favorable safety and efficacy profile but is notably under-prescribed in India.

Purpose of the Study:

  • To address the underutilization of ARNI in India.
  • To discuss the role of ARNI in managing cardiac remodeling and promoting cardiac reverse remodeling (CRR).
  • To provide expert consensus on optimizing ARNI therapy for improved patient prognosis.

Main Methods:

  • Expert consensus-based discussion and recommendations.
  • Review of current guidelines and clinical evidence for ARNI in HF management.
  • Focus on early intervention and effective dosage strategies for ARNI.

Main Results:

  • ARNI is crucial for managing adverse cardiac remodeling and achieving CRR.
  • Early and appropriate dosing of ARNI can significantly improve mortality and morbidity in HF patients.
  • Addressing barriers to ARNI prescription is essential for maximizing its benefits.

Conclusions:

  • Optimizing ARNI utilization in India is critical for improving HF patient care.
  • Timely and effective ARNI intervention is key to enhancing cardiac reverse remodeling.
  • Expert consensus supports the early use of ARNI to improve long-term outcomes in heart failure.

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