Authors:
Jessica Wooster, PharmD, BCACP
Elizabeth Yett, PharmD, BCACP
Reviewers:
Dawn Fuke, PharmD, BCPS, BCACP
Dustin (DJ) Clark, PharmD, BCACP
Jay Pitcock, PharmD, BCPS
Citation:
Heidenreich PA, Bozkurt B, Agullar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 0:10.1161/CIR.0000000000001063.
Introduction
Sacubitril/valsartan (Entresto®) is considered part of the backbone of guideline-recommended therapies for the management of patients with heart failure. Sacubitril/valsartan was initially approved in 2015 as an alternative to an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB). However, in 2021, sacubitril/valsartan became the preferred treatment over an ACEi/ARB in patients with heart failure with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in nearly all adult patients with chronic heart failure, regardless of their left ventricular ejection fraction (LVEF); nonetheless, the benefits are clearly evident in patients with left ventricular ejection fraction below normal. All clinicians should be familiar with the indications, dosing, safety, and monitoring of sacubitril/valsartan. Affordability, access, and inappropriate dose titration remain major barriers to achieving optimal outcomes, meaning pharmacists can play a major role in making this life-saving and cost-effective therapy available to more patients.
This commentary reviews the top ten things every clinician should know about sacubitril/valsartan. This list is in no specific order of importance and is intended to describe the most relevant issues for most practitioners and patients.
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I was a little frustrated by this one. I’m constantly encouraging my providers to pursue guideline directed therapy for their heart failure patients. We don’t do a very good job. I’m trying to parse from these studies how much better over all an ARNI would be in place of an actual appropriately dosed heart failure regimen. I think an intent to treat scenario would favor a more traditional approach when considering cost and the visit intensity required to titrate the ARNI. I think promoting this medication can be more of a distraction than a benefit in the primary care setting.