Patients must be able to tolerate ACEI or ARB before being started on sacubitril/valsartan. Īccording to the 2016 American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America (ACC/AHA/HFSA) Focused Update on New Pharmacological Therapy for Heart Failure, ACEI, ARB, or ARNI are now recommended in patients with chronic symptomatic HFrEF to reduce morbidity and mortality (class I recommendation). Sacubitril/valsartan is to be used in place of an ACEI or angiotensin II receptor blocker (ARB) and conjunction with other standard heart-failure treatments (beta-blocker, aldosterone antagonist). The medication is FDA-approved to treat patients with chronic heart failure with reduced ejection fraction (HFrEF) with NYHA class II, III, or IV. Sacubitril/valsartan is the first agent to be approved in a new class of drugs called angiotensin receptor neprilysin inhibitor (ARNI).
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