Springer US
New York
Springer
10741
10.1007/10741.1573-7322
1382-4147
1573-7322
30930148
Heart Failure Reviews
Heart Fail Rev
Medicine & Public Health
Cardiology
Medicine
24
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2019
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2019
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2019
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Springer Science+Business Media, LLC, part of Springer Nature
2019
9757
10.1007/s10741-018-9757-1
1
Practical guidance on the use of sacubitril/valsartan for heart failure
167
176
2018
11
19
2018
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The Author(s)
2018
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
10741
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Andrew
J.
Sauer
913-945-9344
asauer@kumc.edu
Robert
Cole
Brian
C.
Jensen
Jay
Pal
Nakul
Sharma
Amin
Yehya
Justin
Vader
0000 0001 2106 0692
grid.266515.3
Center for Advanced Heart Failure and Heart Transplantation
The University of Kansas Health System
3901 Rainbow Boulevard Mailstop 1072
Kansas City
KS
66160
USA
0000 0001 0941 6502
grid.189967.8
Center for Heart Failure Therapy and Transplantation
Emory University
Atlanta
GA
USA
0000000122483208
grid.10698.36
UNC McAllister Heart Institute
The University of North Carolina at Chapel Hill
Chapel Hill
NC
USA
0000 0001 0703 675X
grid.430503.1
Division of Cardiothoracic Surgery
University of Colorado
Aurora
CO
USA
0000 0004 1936 7697
grid.22072.35
Libin Cardiovascular Institute of Alberta, Cummings School of Medicine
University of Calgary
Calgary
Alberta
Canada
0000 0004 0432 8548
grid.418635.d
Advanced Heart Failure and Heart Transplant
Piedmont Heart Institute
Atlanta
GA
USA
0000 0001 2355 7002
grid.4367.6
Department of Medicine, Division of Cardiology
Washington University in St Louis
St Louis
MO
USA
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.
Keywords
Heart failure
Sacubitril/valsartan
Cardiovascular
Angiotensin receptor-neprilysin inhibitor
Reduced ejection fraction
ftp_PUB_19-02-23_05-10-13.zip10741-2018-Article-9757.pdfPDF1.4