Open AccessKey Considerations For Integrating Sacubitril/Valsartan Into Chronic Heart Failure Management
Author(s) -
Matthew Lillyblad
Publication year - 2018
Publication title -
journal of the minneapolis heart institute foundation/journal of the minneapolis heart institute foundation
Language(s) - English
Resource type - Journals
eISSN - 2475-0204
pISSN - 2475-0190
DOI - 10.21925/mplsheartjournal-d-18-00014.1
Subject(s) - sacubitril , valsartan , sacubitril, valsartan , heart failure , medicine , ejection fraction , intensive care medicine , cardiology , neprilysin , angiotensin receptor , angiotensin ii , blood pressure , biochemistry , chemistry , enzyme
Heart failure with reduced ejection fraction remains a prevalent clinical syndrome associated with significant morbidity and mortality. Despite significant advances in heart failure with reduced ejection fraction pharmacotherapy, 5-year mortality remains 50%. Sacubitril/valsartan is a first-in-class angiotensin-receptor-neprilysin inhibitor, Food and Drug Administration–approved to reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure with reduced ejection fraction. Sacubitril/valsartan is recognized as a significant therapeutic advancement and endorsed by national guidelines, yet adoption into clinical practice has lagged across the United States. Recommendations for use differ greatly between the Prospective Comparison of Angiotensin-Receptor-Neprilysin Inhibitor with Angiotensin-Converting-Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure clinical trial, international guidelines, and the Food and Drug Administration-approved labeling, which can lead to uncertainty with prescribing. It is essential to establish an evidence-based, pragmatic approach to patient selection and management of sacubitril-valsartan facilitate integration into clinical practice. This review summarizes the pharmacology of sacubitril/valsartan, its known benefits and risks, and important considerations for incorporating sacubitril/valsartan into chronic heart failure management.