Practical considerations on the introduction of sacubitril/valsartan in clinical practice: Current evidence and early experience

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• 作者：Dimitrios Farmakis^a ; ^{dimitrios_farmakis@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Vassiliki Bistola^a ; Apostolos Karavidas^b ; John Parissis^a
• 关键词：Sacubitril/valsartan ; LCZ696 ; Chronic heart failure ; Heart failure with reduced ejection fraction ; Drug therapy
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 November 2016
• 年：2016
• 卷：223
• 期：Complete
• 页码：781-784
• 全文大小：275 K

文摘

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.