Angiotensin Receptor Neprilysin Inhibitor (ARNI) for Heart Failure with Reduced Ejection Fraction – Early Clinical Experience in Institut Jantung Negara

2017 ◽  
Vol 249 ◽  
pp. S37
Author(s):  
A. Mohd Ghazi ◽  
A. Roslan ◽  
D. Chew ◽  
A.A. Abdul Rahim
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Experience ◽  
Angiotensin Receptor ◽  
Reduced Ejection Fraction ◽  
Early Clinical Experience ◽  
Neprilysin Inhibitor ◽  
Angiotensin Receptor Neprilysin Inhibitor

scholarly journals Key Considerations For Integrating Sacubitril/Valsartan Into Chronic Heart Failure Management

2018 ◽  
Vol 2 (2) ◽  
pp. 34-43
Author(s):  
Matthew P. Lillyblad
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Drug Administration ◽  
Angiotensin Receptor ◽  
Heart Failure Management ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
Angiotensin Receptor Neprilysin Inhibitor

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.

scholarly journals Effect of Angiotensin Receptor-Neprilysin Inhibitor and Sodium-Glucose Co-transporter-2 Inhibitor Combination Therapy in Diabetic Patients with Heart Failure with Reduced Ejection Fraction: A Retrospective Study

2021 ◽  
Author(s):  
Hyue Mee Kim ◽  
In-Chang Hwang ◽  
Wonsuk Choi ◽  
Yeonyee E. Yoon ◽  
Goo-Yeong Cho
Keyword(s):  
Heart Failure ◽  
Combination Therapy ◽  
Ejection Fraction ◽  
Diabetic Patients ◽  
Angiotensin Receptor ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
Patients With Heart Failure ◽  
Angiotensin Receptor Neprilysin Inhibitor ◽  
Group 1

Abstract Background Angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose co-transporter-2 inhibitor (SGLT2i) have shown robust benefits in improving cardiac function and disease prognosis in diabetic patients with heart failure with reduced ejection fraction (HFrEF). However, their combined effect has not been revealed. Methods We retrospectively identified diabetic patients with HFrEF who were prescribed an ARNI and/or SGLT2i. Diabetic patients with HFrEF treated with standard HF therapy but not ARNI or SGLT2i were included as controls. The patients were divided into groups treated with both ARNI and SGLT2i (group 1), ARNI but not SGLT2i (group 2), SGLT2i but not ARNI (group 3), and neither ARNI nor SGLT2i (group 4). After propensity score-matching, the occurrence of hospitalization for heart failure (HHF), cardiovascular mortality, and changes in echocardiographic parameters were analyzed. Results Of the 206 matched patients included in the study, 90 (43.7%) had to undergo HHF and 43 (20.9%) died of cardiovascular causes during a median 25 months of follow-up. Patients in group 1 exhibited a lower risk of HHF and cardiovascular mortality compared to those in the other groups. Improvements in the left ventricular ejection fraction and mitral E/e’ were more pronounced in group 1 than in groups 2, 3 and 4. These echocardiographic improvements were more prominent after the initiation of ARNI, compare to the initiation of SGLT2i. Conclusion In diabetic patients with HFrEF, combination of ARNI and SGT2i showed significant improvement in cardiac function and prognosis. ARNI-SGLT2i combination therapy may improve the clinical course of HFrEF in diabetic patients.

Sacubitril/Valsartan (Entresto®)-Induced Hyponatremia

2019 ◽  
Vol 33 (5) ◽  
pp. 696-699 ◽  
Author(s):  
Ilana Fuzaylova ◽  
Chester Lam ◽  
Om Talreja ◽  
Amgad N. Makaryus ◽  
Deborah Ahern ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Elderly Woman ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Receptor ◽  
Angiotensin Ii Receptor ◽  
Combination Drug ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
Angiotensin Receptor Neprilysin Inhibitor

Sacubitril/valsartan (Entresto®) is the first commercially available angiotensin receptor neprilysin inhibitor (ARNI) approved for use in heart failure patients with a reduced ejection fraction. It is a combination drug that contains sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin II receptor blocker. Our report outlines a case of probable ARNI-induced hyponatremia occurring in an elderly woman with heart failure with a reduced ejection fraction. According to Naranjo Adverse Drug Reaction Assessment, score indicated a likely association between patient’s hyponatremia and her use of sacubitril/valsartan.

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