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Impact of Sacubitril/Valsartan on Patient Outcomes in Heart Failure: Evidence to Date

Authors Akbar S, Kabra N, Aronow WS

Received 1 May 2020

Accepted for publication 14 July 2020

Published 29 July 2020 Volume 2020:16 Pages 681—688

DOI https://doi.org/10.2147/TCRM.S224772

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Garry Walsh


Sara Akbar,1,2 Nitin Kabra,1,2 Wilbert S Aronow1,2

1Department of Cardiology, Westchester Medical Center, Valhalla, NY 10595, USA; 2Department of Medicine, New York Medical College, Valhalla, NY 10595, USA

Correspondence: Wilbert S Aronow
Director of Cardiology Research, Department of Cardiology, Westchester Medical Center, Macy Pavilion, Room 141, Valhalla, NY 10595, USA
Tel +1 (914)-493-5311
Fax +1 (914)-235-6274
Email wsaronow@aol.com

Abstract: With an estimated 6.2 million adults affected in the USA, heart failure remains a leading cause of morbidity, mortality, and health-care costs, despite the use of guideline-based medical therapies. The search for a more efficient therapy was rekindled when findings from the Prospective Comparison of Angiotensin Receptor–Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial demonstrated evidence for cardiovascular and mortality benefit of sacubitril/valsartan, a dual angiotensin receptor blocker and neprilysin inhibitor (ARNI), over enalapril (an angiotensin-converting enzyme inhibitor) in patients with heart failure and reduced rjection fraction (HFrEF). Following the trial’s compelling results, recommendations for the use of sacubitril/valsartan as a replacement for an angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker were incorporated into the 2016 American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Failure Society of America recommended (HFSA) guidelines for the management of heart failure. This review aims to gain insight into the benefits as well as limitations associated with the use of sacubitril/valsartan in the treatment of heart failure (HF) through exploration of various subgroup analyses of the PARADIGM-HF trial, subsequent retrospective analyses, and randomized controlled trials that followed this landmark trial.

Keywords: heart failure with reduced ejection fraction, angiotensin receptor–neprilysin inhibitor, sacubitril/valsartan, heart failure hospitalization, cardiovascular death, clinical outcome

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