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

• Type of Material: Article
• Authors: Andrew J. Sauer, University of Kansas Health System; Robert Cole, Emory University; Brian C. Jensen, University of North Carolina; Jay Pal, University of Colorado; Nakul Sharma, University of Calgary; Amin Yehya, Piedmont Heart Institute; Justin Vader, Washington University
• Language: English
• Date: 2018-12-18
• Publisher: Springer (part of Springer Nature): Springer Open Choice Hybrid Journals
• Publication Version: Final Published Version
• Copyright Statement: Copyright © The Author(s) 2018
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s10741-018-9757-1
• Title of Journal or Parent Work: Heart Failure Reviews
• ISSN: 1382-4147
• Volume: 24
• Issue: 2
• Start Page: 167
• End Page: 176
• Grant/Funding Information: Medical writing assistance for this manuscript was provided by Oxford PharmaGenesis, Inc., Newtown, Pennsylvania, USA; and was funded by Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA.
• Keywords: Reduced ejection fraction; Sacubitril/valsartan; Cardiovascular; Angiotensin receptor-neprilysin inhibitor; Heart failure
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) that has been recommended in clinical practice guidelines to reduce morbidity and mortality in patients with chronic, symptomatic heart failure (HF) with reduced ejection fraction (HFrEF). This review provides an overview of ARNI therapy, proposes strategies to improve the implementation of sacubitril/valsartan in clinical practice, and provides clinicians with evidence-based, practical guidance on the use of sacubitril/valsartan in patients with HFrEF. Despite evidence demonstrating the benefits of ARNI therapy over standard of care, only a fraction of eligible patients takes sacubitril/valsartan. Barriers preventing the prescription of sacubitril/valsartan in eligible patients may include practitioners’ unfamiliarity with ARNIs, safety concerns, and payer reimbursement issues. The optimal implementation of sacubitril/valsartan in clinical practice has the potential to reduce the overall burden of HF. Throughout this review, we describe our experience with sacubitril/valsartan, including strategies for the management of adverse events and common patient concerns. In addition, a strategy for the gradual introduction of sacubitril/valsartan using a treatment sequence scheme is proposed.