Angiotensin-Converting Enzyme Inhibitor Washout Period Prior to Angiotensin Receptor/Neprilysin Inhibitor Initiation...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Pharmacy

Background:

• The 2022 AHA-ACC HFSA Guideline recommends Angiotensin Receptor/Neprilysin Inhibitors (ARNIs) for heart failure with reduced ejection fraction (HFrEF).
• A 36-hour washout period is advised when switching from Angiotensin-Converting Enzyme Inhibitors (ACEi) to ARNIs to mitigate adverse effects like angioedema.
• This study examines adherence to this washout protocol in a real-world clinical setting.

Purpose of the Study:

• To determine the rate of adherence to the 36-hour washout period when transitioning patients from ACEi to ARNI.
• To evaluate secondary outcomes including 90-day heart failure exacerbation readmissions and adverse events (angioedema, hypotension, AKI, hyperkalemia).

Main Methods:

• Retrospective cohort study of HFrEF patients transitioned from ACEi to ARNI between March 2016 and December 2022.
• Exclusion criteria included lack of ACEi or ARNI use during admission or ejection fraction >40%.
• Pearson chi-square analysis was used for categorical data.

Main Results:

• Of 33 patients, only 67% received the full 36-hour washout period.
• No significant differences were observed in hospital readmission rates or adverse events between groups.
• No patients experienced hyperkalemia or angioedema.

Conclusions:

• This study highlights potential deviations from recommended washout protocols when switching from ACEi to ARNI in HFrEF patients.
• The observed adherence rate suggests a need for further investigation into prescribing practices.
• Larger, multicenter studies are warranted to validate these findings and explore the pharmacist's role in protocol adherence.