title: Practical considerations on the introduction of sacubitril/valsartan in clinical practice: Current evidence and early experience.
abstract: The combination of neprilysin inhibitor sacubitril with the angiotensin II receptor 1 blocker valsartan is the first agent from the angiotensin receptor neprilysin inhibitors (ARNI) class authorized for clinical use in heart failure (HF) patients with reduced ejection fraction (HFrEF). Sacubitril/valsartan resulted in 20% reduction in the incidence rate of death or HF hospitalization compared to enalapril in symptomatic HFrEF patients in the seminal PARADIGM-HF trial. As a result, the recently updated European and American HF guidelines granted this agent a class IB indication for the treatment of ambulatory/chronic symptomatic HFrEF patients. However, translating the positive results of trials into true clinical benefit is often challenging. This is particularly true in the case of sacubitril/valsartan, as HF is a heterogeneous syndrome including many severely ill patients who are prone to decompensation, while this new agent comes to replace a cornerstone of current evidence-based HF therapy. In the present paper, we address a number of practical issues regarding the introduction of sacubitril/valsartan and propose an algorithm based on available evidence and early clinical experience.
authors: Heart Failure Unit, Department of Cardiology, "Attikon" University Hospital, National and Kopodistrian University of Athens, Greece. Electronic address: dimitrios_farmakis@yahoo.com.
authors: Dimitrios
authors: D
authors: Farmakis
authors: Heart Failure Unit, Department of Cardiology, "Attikon" University Hospital, National and Kopodistrian University of Athens, Greece.
authors: Vassiliki
authors: V
authors: Bistola
authors: Department of Cardiology, "G. Gennimatas" General Hospital, Athens, Greece.
authors: Apostolos
authors: A
authors: Karavidas
authors: Heart Failure Unit, Department of Cardiology, "Attikon" University Hospital, National and Kopodistrian University of Athens, Greece.
authors: John
authors: J
authors: Parissis
mesh_terms: D000613:Aminobutyrates / Q000008:administration & dosage*; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage*; D001713:Biphenyl Compounds; D002986:Clinical Trials as Topic / Q000379:methods; D004338:Drug Combinations; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D013318:Stroke Volume / Q000187:drug effects* / Q000502:physiology; D013777:Tetrazoles / Q000008:administration & dosage*; D000068756:Valsartan
chemical_list: D000613:Aminobutyrates; D057911:Angiotensin Receptor Antagonists; D001713:Biphenyl Compounds; D004338:Drug Combinations; D013777:Tetrazoles; D000068756:Valsartan; C549068:sacubitril and valsartan sodium hydrate drug combination
keywords: Chronic heart failure; Drug therapy; Heart failure with reduced ejection fraction; LCZ696; Sacubitril/valsartan