The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement (original) (raw)
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JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Introduction: Combination of Angiotensin Receptor and Neprilysin Inhibitors (ARNI) has become the mainstay drug in treatment of Heart Failure (HF) with reduced Ejection Fraction (HFrEF). However, there are very few studies to evaluate the extent and spectrum of benefit of ARNI therapy in Indian HFrEF patients. Aim: To observe the benefits of sacubitril/valsartan (ARNI) therapy on left ventricle function, parameters of cardiac remodelling, N terminal pro Brain-natriuretic peptide (NT-proBNP), rate of rehospitalisation for HF and detailed subgroup analysis in symptomatic HFrEF patients who are already receiving optimal medical therapy. Materials and Methods: This longitudinal study was conducted at Cardiology Department of Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from September 2018 to August 2020. Total 200 patients of HFrEF with previous echocardiographic records of past 6 months, who did not show any further improvement in left ventri...
Kardiologia polska, 2018
Sacubitril/valsartan is the first drug from a new class of angiotensin receptor neprilysin inhibitors (ARNIs) recommended in the new European Society of Cardiology guidelines instead of angiotensin converting enzyme inhibitors (ACEI), or angiotensin receptor blockers (ARB) that are used if ACEI are not tolerated. Sacubitril/valsartan is recommended for further reduction in the risk of hospitalisation or death in outpatients with heart failure with reduced ejection fraction (HFrEF) if symptoms continue despite optimal treatment with ACEI/ARB, beta-blockers, and mineralocorticoid antagonists. The aim of this study is to present the initial experience with regard to the effectiveness, tolerance, and safety of sacubitril/valsartan in the outpatient cardiology practice in Poland. The study is a retrospective analysis of data obtained through a questionnaire filled in by the physicians who initiated the sacubitril/valsartan treatment in patients with HFrEF between 1 June 2016 and 30 Septe...
Research Reports in Clinical Cardiology
This study analyzes the safety and efficacy of LCZ696 (valsartan/sacubitril), a combination of angiotensin II receptor blocker and neprilysin inhibitor (ARNI), in patients with heart failure and preserved ejection fraction (HFpEF). Patients and Methods: An observational pilot study was conducted using a prospective design. A sample of 50 HFpEF patients (27 females and 23 males) was included on LCZ696 (50 mg orally, twice daily), which was then titrated up to a maximum tolerated dose, and followed up in the outpatient clinic. Thirty-seven patients received LCZ696 during hospitalization for decompensated heart failure or before their discharge while same titration was followed for the remaining patients. Results: Patients were classified as New York Heart Association (NYHA) class III (64%), NYHA class IV (22%), and NYHA class II (14%). Diabetes mellitus was found in 74% of patients, while hypertension in 94%. Rapid clinical improvement was found with significant reduction in NYHA class down to NYHA class II (p=0.018). Patients had cleared off the fine basal crackles (specific for the interstitial pulmonary disease) secondary to heart failure (p<0.001) and improvement or disappearance of edema of the lower limbs (p<0.001). Heart rate response and jugular venous pressure and NT-pro-BNP were reduced significantly (p-value <0.001, 0.005, respectively). Echocardiographic criteria for diastolic LV dysfunction (primarily E/A ratio) improved (p=0.001). Serum sodium (NA) levels improved significantly (p=0.015), without worsening renal function or limiting hyperkalemia. Conclusion: LCZ696 (sacubitril/valsartan; ARNI) led to significant clinical improvements in patients with HFpEF. Further, a randomized study is needed to test whether it leads to positive outcomes for a larger sample.
Pakistan Heart Journal
Objectives: This is a real world prospective study to evaluate the effects of Neprlysin Inhibition (ARNI) using sacubitril/valsartan in patients with heart failure with reduced ejection fraction (HFrEF). Methodology: This was an outpatient study on patients of HFrEF (EF<40%) and stable blood pressure after obtaining informed consent. Consecutive patients were enrolled and followed at 6 and 12 weeks. Detailed clinical and echocardiographic examinations were performed on all visits. Biochemistry evaluating ProBNP, renal profile, HbA1C and electrolytes were performed in 24 patients at baseline and follow-up. Results: We enrolled 80 patients, but 63 patients could be followed. Mean age was 53.54±13.32 years and 55% were males. After 12 weeks treatment improvement in NYHA functional class was seen in 66% and improvement by more than one grade in 31% (p<0.01). Pro-BNP reduced from 3552.71±1804.74 at the baseline to 723±930 on the second FU visit (p<0.002). Structural improvement...
Journal of Pharmaceutical Research International
This review article discusses the Angiotensin Receptor-Neprilysin Inhibitor which is remedy made up of two anti-hypertensive pharmaceuticals (sacubitril and valsartan). These medications may prolong life expectancy more than ACE inhibitors, which have been routinely used to treat heart failure. ARNi is now being used to treat individuals with heart failure those who have a low ejection fraction, which means their basic pumping chamber isn't working properly. Patients must be symptomatic despite receiving effective medical treatment for heart failure or be unable to tolerate a sufficient dose of ACE inhibitors to be eligible. Sacubitril and/or Valsartan are the debut members of a latest class of drugs described as angiotensin receptor neprilysin inhibitors to receive FDA approval (ARNI). The FDA has approved the medicine for the management of chronic heart failure sufferers with a lower ejection fraction and NYHA classifications II, III, or IV. Before commencing sacubitril and/or...
Open Journal of Internal Medicine, 2020
Background: Heart failure with reduced ejection fraction has a significant association with considerable morbidity and mortality, but there is still inadequacy in appropriate treatment to prevent this condition. We observed the effect of angiotensin receptor neprilysin inhibitor (ARNi) with such disorder compared to valsartan. Methods: In this single-blind trial, the patients were enrolled with chronic HF aged on or above 40 years, symptomatic NYHA class II-IV, an elevated NT-proBNP above 400 pg/ml level and a reduced LVEF of 40% or less. The patients were randomly assigned 1:1 to the treatment arms either ARNi (50 mg titrated to 100 mg twice a day) or valsartan (40 mg titrated to 80 mg twice a day) and followed for a median of 88 days. The primary outcome was mode of cardiovascular death and re-hospitalization for heart failure. Changes in the level of NT-proBNP and rate of ejection fraction were also measured. Results: Cardiovascular deaths occurred 4 (8%) in the ARNi treatment arm, while 11 (22%) in the valsartan treatment arm with significant hazard ratio in the ARNi group [Hazard Ratio = 0.37; 95% CI: 0.34, 0.64; p = 0.042] during a median of 88 days of follow up period and 2 (4%) of the patients from the ARNi treatment arm were hospitalized due to HF, while in the valsartan treatment arm, 10 (20%) patients were hospitalized due to HF followed by receiving treatment respectively with hazard ratio in the ARNi group [Hazard Ratio = 0.
Journal of Indian College of Cardiology, 2020
Impact on Global Mortality and Morbidity in Heart Failure trial" (PARADIGM-HF) showed that sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI) was superior to the angiotensin-converting enzyme inhibitor (ACEI) enalapril in reducing the risk of CV and all-cause death, hospitalization for HF, and decline in quality of life in patients with HF and reduced ejection fraction (HFrEF). 4,5 Burnett et al conducted a network meta-analysis T he aging population and rising prevalence of various cardiovascular (CV) risk factors, such as hypertension and diabetes, in Japan imply that a considerable proportion of the population will continue to develop heart failure (HF). By the year 2025, the annual incidence of new-onset HF in Japanese individuals aged ≥65 years (≈31% of total population) is estimated to be >0.37 million, emphasizing the need for effective treatments in patients with HF.
Objective: To describe the efficacy, superiority and safety profile of the first-in-class angiotensin receptorneprilysin inhibitor "Sacubitril/Valsartan" and angiotensin II receptor blocker (ARB) in heart failure (HF) patients, reviewing data available from both clinical and pre-clinical studies. Evidences on health care utilization outcomes. Inhibition of neurohumoural pathways such as the renin angiotensin aldosterone and sympathetic nervous systems is central to the understanding and treatment of heart failure (HF). Conversely, until recently, potentially beneficial augmentation of neurohumoural systems such as the natriuretic peptides has had limited therapeutic success. Administration of synthetic natriuretic peptides has not improved outcomes in acute HF but modulation of the natriuretic system through inhibition of the enzyme that degrades natriuretic (and other vasoactive) peptides, neprilysin, has proven to be successful. After initial failures with neprilysin inhibition alone or dual neprilysin-angiotensin converting enzyme (ACE) inhibition, the Prospective comparison of angiotensin receptor neprilysin inhibitor (ARNI) with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF) trial demonstrated that morbidity and mortality can be improved with the angiotensin receptor blocker neprilysin inhibitor sacubitril/valsartan (formerly LCZ696). These findings suggest that sacubitril/valsartan should replace an ACE inhibitor or angiotensin receptor blocker as the foundation of treatment of symptomatic patients (NYHA II-IV) with HF and a reduced ejection fraction.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Introduction: Angiotensin Receptor Neprilysin Inhibitor (ARNI) has shown to reduce morbidity and mortality in comparison to Angiotensin Converting Enzyme Inhibitors (ACEI) inpatients of Heart Failure with Reduced Ejection Fraction (HFrEF). However, the use of ARNI in real-world practice is limited and has not been studied in North Eastern Indian population. Aim: To compare the efficacy and safety of ARNI with ACEI in the management of symptomatic chronic HFrEF in North Eastern Indian population. Materials and Methods: The prospective observational study was conducted in the Department of Cardiology at Gauhati Medical College, Guwahati, Assam, India, from April 2019 to October 2020. The study included patients with diagnosis of chronic HFrEF <40%, on ACEI therapy and who had atleast one hospitalisation for Acute Decompensated Heart Failure (ADHF) in the last 6 months. A total of 63 patients were included in this study. Three patients were lost on follow-up. Out of the 60 patients ...