Angiotensin receptor-neprilysin inhibition in patients with acute decompensated heart failure: an expert consensus position paper

Ntalianis, Argyrios; Chrysochoou, Christina; Giannakoulas, George; Giamouzis, Grigorios; Karavidas, Apostolos; Naka, Aikaterini; Papadopoulos, Constantinos; Patsilinakos, Sotirios; Parissis, John; Tziakas, Dimitrios; Kanakakis, John

doi:10.1007/s10741-021-10115-8

Cited by 7 publications

(7 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The first 12 weeks after discharge is considered the at-risk phase. Almost 50% of rehospitalizations arise in this phase [ 3 ]. In ambulatory patients with HFrEF who remain symptomatic even after optimal medical treatment, the previous recommendation was ACEI or ARB which is currently replaced by sacubitril/valsartan [ 22 ].…”

Section: Reviewmentioning

confidence: 99%

“…If initiated early in the hospitalization course instead of late or post-discharge initiation, it can save $811 per year. Inpatient initiation of the drug was associated with an improved overall cost-benefit ratio of $21,532 per quality-adjusted life-year (QALY) compared with continuous enalapril treatment for a lifetime [ 3 ].…”

Section: Reviewmentioning

confidence: 99%

“…The rate of re-admissions for HF patients also remains very high. According to an expert consensus position paper, the percentage of HF patients with readmission for all causes, either cardiac or non-cardiac, within 365 days post-discharge is as high as 44% [ 3 ]. The primary basic mechanism underlying the progression of HF is cardiac remodeling.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Sacubitril/Valsartan in Heart Failure Hospitalization: Two Pills a Day to Keep Hospitalizations Away?

Sakhamuri¹,

Athiyaman²,

Randhi³

et al. 2023

Cureus

View full text Add to dashboard Cite

Heart failure (HF) is a clinical syndrome with signs and symptoms that result from any structural or functional deterioration of ventricular filling or ejection of blood. It is the final stage of various cardiovascular diseases (e.g., coronary artery disease, hypertension, previous myocardial infarction) and remains one of the leading causes of hospitalization. It poses severe health and economic burden worldwide. Patients usually present with shortness of breath due to impaired cardiac ventricular filling and decreased cardiac output. Cardiac remodeling due to the renin-angiotensin-aldosterone system overactivation is the final pathological mechanism leading to these changes. The natriuretic peptide system is also activated to stop the remodeling. Sacubitril/valsartan, an angiotensin-receptor neprilysin inhibitor, has prompted a substantial conceptual change in HF treatment. Its primary mechanism is the inhibition of cardiac remodeling and the prevention of natriuretic peptide degradation by inhibiting the enzyme neprilysin. It is an efficacious, safe, and cost-effective therapy that improves the quality of life and survival rate in patients with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction. It has been demonstrated to significantly reduce hospitalization rates and rehospitalization for HF when compared to enalapril.In this review, we have discussed the benefits of sacubitril/valsartan in treating patients with HFrEF, particularly in reducing hospitalizations and readmissions. We have also compiled studies to examine the drug's effect on adverse cardiac events. Finally, the cost benefits of the drug and optimal dosing strategies are also reviewed. Our review article, combined with the recommendations of the 2022 American Heart Association guidelines for heart failure, strongly suggests that sacubitril/valsartan is a cost-effective strategy that reduces hospitalizations for HFrEF patients when started early with optimal doses. There is still much uncertainty regarding the optimal usage of this drug, its use in HFrEF, and the cost benefits when used alone compared with enalapril.

show abstract

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sacubitril/Valsartan in Heart Failure Hospitalization: Two Pills a Day to Keep Hospitalizations Away?

Sakhamuri¹,

Athiyaman²,

Randhi³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Early initiation was well tolerated in both groups and maintenance of target dose 10-week post-randomization was comparable between the two groups. In light of these two clinical trials, an expert consensus position paper provided a comprehensive algorithm for in-hospital initiation of sac/val as well as for management of hypotension [ 57 ]. Ntalianis et al proposed four criteria for determination of clinical stability: (i) SBP equal to or greater than 100 mmHg for 6–12 h prior to the initiation, (ii) euvolemia, (iii) stable dose of intravenous diuretics for the past 6–12 h or preferably oral diuretics, (iv) no need for intravenous vasodilators, vasopressors, or inotropes for the last 6–12 h. In patients with SBP ≥ 100 mmHg, the lower dose of 24/26 mg should be preferred for initiation.…”

Section: Managementmentioning

confidence: 99%

Contemporary Data on the Status and Medical Management of Acute Heart Failure

et al. 2022

View full text Add to dashboard Cite

Purpose of Review Acute heart failure (AHF) is among the leading causes for unplanned hospital admission. Despite advancements in the management of chronic heart failure, the prognosis of AHF remains poor with high in-hospital mortality and increased rates of unfavorable post-discharge outcomes. With this review, we aim to summarize current data on AHF epidemiology, focus on the different patient profiles and classifications, and discuss management, including novel therapeutic options in this area. Recent Findings There is significant heterogeneity among patients admitted for AHF in their baseline characteristics, heart failure (HF) aetiology and precipitating factors leading to decompensation. A novel classification scheme based on four distinct clinical scenarios has been included in the most recent ESC guidelines, in an effort to better risk stratify patients and guide treatment. Intravenous diuretics, vasodilators, and inotropes remain the cornerstone of management in the acute phase, and expansion of use of mechanical circulatory support has been noted in recent years. Meanwhile, many treatments that have proved their value in chronic heart failure demonstrate promising results in the setting of AHF and research in this field is currently ongoing. Summary Acute heart failure remains a major health challenge with high in-hospital mortality and unfavorable post-discharge outcomes. Admission for acute HF represents a window of opportunity for patients to initiate appropriate treatment as soon as possible after stabilization. Future studies are needed to elucidate which patients will benefit the most by available therapies and define the optimal timing for treatment implementation.

show abstract

“…In one of the latest expert consensuses, Ntalianis A et al described the role of sacubitril/valsartan in patients with ADHF [32]. The study concluded that sacubitril/valsartan is safe and well-tolerated and results in a significant reduction of NT-proBNP and reduction for HF rehospitalizations.…”

Section: Limitationsmentioning

confidence: 99%

Efficacy of Sacubitril/Valsartan in the Setting of Acute Heart Failure: A Systematic Review

Mohyeldin¹,

Tavares²,

Boorenie³

et al. 2021

Cureus

View full text Add to dashboard Cite

Acute decompensated heart failure (ADHF) is one of the conditions associated with high rates of mortality and morbidity, in addition to its economic burden. Sacubitril/valsartan, the emerging drug in the field of heart failure, has been showing favorable outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, its efficacy in patients with acute decompensated heart failure remains obscure. This systematic review aims to offer more clarity to this established gap of knowledge. PubMed, ScienceDirect, and ScienceOpen were explored to gain access to studies on this topic. We conducted a systematic review to evaluate the safety and efficacy of using sacubitril/valsartan in the acute setting. Five clinical trials, 10 observational studies, including two abstracts, in addition to seven case reports and one editorial, were obtained and analyzed. Key outcomes of interest were safety and tolerability, efficacy reflected by N-terminal proB-type natriuretic peptide (NT-proBNP), and other serum and echocardiographic parameters. Additionally, target dose attainment, rehospitalization rates, and hemodynamics effect were also outcomes of interest. Based on our findings, the use of sacubitril/valsartan in patients with ADHF and cardiogenic shock is an effective measure. Although most of the results pointed to its safety, some of them showed the outcome of serious adverse events recommending its cautious use.

show abstract

Angiotensin receptor-neprilysin inhibition in patients with acute decompensated heart failure: an expert consensus position paper

Cited by 7 publications

References 60 publications

Sacubitril/Valsartan in Heart Failure Hospitalization: Two Pills a Day to Keep Hospitalizations Away?

Sacubitril/Valsartan in Heart Failure Hospitalization: Two Pills a Day to Keep Hospitalizations Away?

Contemporary Data on the Status and Medical Management of Acute Heart Failure

Efficacy of Sacubitril/Valsartan in the Setting of Acute Heart Failure: A Systematic Review

Contact Info

Product

Resources

About