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sacubitril, valsartan

Orly Vardeny, Brian Claggett, Jessica Kachadourian, Akshay S Desai, Milton Packer, Jean Rouleau, Michael R Zile, Karl Swedberg, Martin Lefkowitz, Victor Shi, John J V McMurray, Scott D Solomon
AIMS: To assess differences in diuretic dose requirements in patients treated with sacubitril/valsartan compared with enalapril in the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF) trial. METHODS AND RESULTS: Overall, 8399 patients with New York Heart Association class II-IV heart failure and reduced LVEF were randomized to sacubitril/valsartan 200 mg bid or enalapril 10 mg twice daily...
February 11, 2019: European Journal of Heart Failure
Jozine M Ter Maaten
No abstract text is available yet for this article.
February 11, 2019: European Journal of Heart Failure
Nancy Luo, Steven J Lippmann, Robert J Mentz, Melissa A Greiner, Bradley G Hammill, N Chantelle Hardy, Warren K Laskey, Paul A Heidenreich, Chun-Lan Chang, Adrian F Hernandez, Lesley H Curtis, Pamela N Peterson, Gregg C Fonarow, Emily C O'Brien
Background The angiotensin-receptor/neprilysin inhibitor ( ARNI ) sacubitril/valsartan reduces hospitalization and mortality for patients with heart failure with reduced ejection fraction. However, adoption of ARNI into clinical practice has been slow. Factors influencing use of ARNI have not been fully elucidated. Using data from the Get With The Guidelines-Heart Failure registry, Hospital Compare, Dartmouth Atlas, and the American Hospital Association Survey, we sought to identify hospital characteristics associated with patient-level receipt of an ARNI prescription...
February 5, 2019: Journal of the American Heart Association
Vinesh Appadurai, Jennifer Thoreau, Theresa Malpas, Mugur Nicolae
BACKGROUND: An improvement in life expectancy in patients suffering from adult congenital heart disease (ACHD) has corresponded with a rise in heart failure incidence within this group. An area that has not been addressed in ACHD heart failure guidelines has been the use of combined inhibition of angiotensin receptor-neprolysin pathways. This case series sought to demonstrate tolerability and 6-month outcome measures of sacubitril/valsartan use in ACHD patients with a severely impaired systemic ventricle...
December 17, 2018: Heart, Lung & Circulation
Cândida Fonseca, Dulce Brito, Jorge Ferreira, Fátima Franco, João Morais, José Silva Cardoso
Renin-angiotensin-aldosterone system (RAAS) inhibitors are a cornerstone in the treatment of heart failure with reduced ejection fraction (HFrEF). Sacubitril/valsartan modulates the neurohormonal axis by inhibiting both angiotensin receptors and neprilysin, and improves neurohormonal balance more than blocking the RAAS alone. The PARADIGM-HF trial validated this new treatment option for patients with HFrEF. Sacubitril/valsartan was also more effective than enalapril in slowing disease progression by decreasing the risk of worsening heart failure requiring hospitalization or emergency admission and the need for intensified therapy, heart failure devices or cardiac transplantation...
January 21, 2019: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Aaqib H Malik, Wilbert S Aronow
BACKGROUND: Sacubitril/valsartan (LCZ696) has progressed to be one of the most promising medication since its approval for chronic heart failure with reduced ejection fraction. Recent data have suggested a superior blood pressure control with LCZ696. STUDY QUESTION: What is the antihypertensive efficacy and safety profile of sacubitril/valsartan? DATA SOURCES: Randomized controlled trials (RCTs) comparing the efficacy and safety of LCZ696 against a placebo or angiotensin receptor blocker (ARB)...
January 10, 2019: American Journal of Therapeutics
Uğur Önsel Türk, Emin Alioğlu
Cardiac implantable electronic devices include remote monitoring tools intended to guide heart failure management. These tools allow for observation of some physiological functions, such as intrathoracic impedance (ITI), patient activity (PA), and heart rate variability (HRV). Sacubitril/valsartan is recommended in the current guidelines as foundational therapy for patients with heart failure and reduced ejection fraction. However, the effects of sacubitril/valsartan treatment on these physiological parameters remain unclear...
January 2019: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Graham H Smith, Supriya Shore, Larry A Allen, David W Markham, Andrea R Mitchell, Miranda Moore, Alanna A Morris, Candace D Speight, Neal W Dickert
Background "Financial toxicity" is a concern for patients, but little is known about how patients consider out-of-pocket cost in decisions. Sacubitril-valsartan provides a contemporary scenario to understand financial toxicity. It is guideline recommended for heart failure with reduced ejection fraction, yet out-of-pocket costs can be considerable. Methods and Results Structured interviews were conducted with 49 patients with heart failure with reduced ejection fraction at heart failure clinics and inpatient services...
January 8, 2019: Journal of the American Heart Association
Duk-Hyun Kang, Sung-Ji Park, Sung-Hee Shin, Geu-Ru Hong, Sahmin Lee, Min-Seok Kim, Sung-Cheol Yun, Jong-Min Song, Seung-Woo Park, Jae-Joong Kim
BACKGROUND: The morbidity and mortality of patients with functional mitral regurgitation (MR) remain high, but no pharmacological therapy has been proven effective. The hypothesis of this study was that sacubitril/valsartan would be superior to valsartan alone in improving functional MR via dual inhibition of the renin-angiotensin system and neprilysin. METHODS: In this double-blind trial, we randomly assigned 118 heart failure patients with chronic functional MR secondary to left ventricular (LV) dysfunction to receive either sacubitril/valsartan or valsartan, in addition to standard medical therapy for heart failure...
December 5, 2018: Circulation
Andrew J Sauer, Robert Cole, Brian C Jensen, Jay Pal, Nakul Sharma, Amin Yehya, Justin Vader
Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) that has been recommended in clinical practice guidelines to reduce morbidity and mortality in patients with chronic, symptomatic heart failure (HF) with reduced ejection fraction (HFrEF). This review provides an overview of ARNI therapy, proposes strategies to improve the implementation of sacubitril/valsartan in clinical practice, and provides clinicians with evidence-based, practical guidance on the use of sacubitril/valsartan in patients with HFrEF...
December 18, 2018: Heart Failure Reviews
Lourdes Vicent, Alberto Esteban-Fernández, Manuel Gómez-Bueno, Javier De-Juan, Pablo Díez-Villanueva, Ángel Manuel Iniesta, Ana Ayesta, Hugo González-Saldívar, Antonio Rojas-González, Ramón Bover-Freire, Diego Iglesias, Marcos García-Aguado, Jesús A Perea-Egido, Manuel Martínez-Sellés
Sacubitril/valsartan (SV) is a new therapy in heart failure with reduced ejection fraction. Our aim was to determine the efficacy and safety of this drug daily clinical practice.We performed a multicenter registry in 10 hospitals. All patients who started SV from October 2016 to March 2017 on an outpatient basis were included.A total of 427 patients started treatment with SV. Mean follow-up was 7.0±0.1 months. Forty-nine patients (11.5%) discontinued SV, and 12 (2.8%) died. SV discontinuation was associated with higher cardiovascular (hazard ratio [HR] 13...
December 10, 2018: Journal of Cardiovascular Pharmacology
Amy X Du, Cynthia M Westerhout, Finlay A McAlister, Miriam Shanks, Gavin Y Oudit, D Ian Paterson, Mikael Hanninen, Jissy Thomas, Justin A Ezekowitz
Little is known about the dosing and tolerability of sacubitril/valsartan (LCZ696; Entresto™, Quebec, Canada) in a non-clinical trial population. This study was conducted to evaluate the use and tolerability of sacubitril/valsartan in patients followed at a multidisciplinary heart failure clinic. We performed a retrospective chart review of 126 patients with heart failure, initiated on sacubitril/valsartan, and seen at a specialty heart failure clinic between August 1, 2015 and August 1, 2017. We defined the target dose of sacubitril/valsartan as 200 mg B...
December 10, 2018: Journal of Cardiovascular Pharmacology
Yong Huo, Weimin Li, Randy Webb, Li Zhao, Qian Wang, Weinong Guo
This study assessed the efficacy and safety of angiotensin receptor neprilysin inhibitor sacubitril/valsartan vs olmesartan in Asian patients with mild-to-moderate hypertension. Patients (N = 1438; mean age, 57.7 years) with mild-to-moderate hypertension were randomized to receive once daily administration of sacubitril/valsartan 200 mg (n = 479), sacubitril/valsartan 400 mg (n = 473), or olmesartan 20 mg (n = 486) for 8 weeks. The primary endpoint was reduction in mean sitting systolic blood pressure (msSBP) from baseline with sacubitril/valsartan 200 mg vs olmesartan 20 mg at Week 8...
December 11, 2018: Journal of Clinical Hypertension
Joanna Osmanska, Pardeep S Jhund
The foundation of the treatment of heart failure with reduced ejection fraction is a number of pharmacotherapies shown to reduce morbidity and mortality in large randomised multinational clinical trials. These include angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and more recently, a combined angiotensin receptor blocker neprilysin inhibitor, sacubitril/valsartan. In select cases, digoxin, ivabradine and hydralazine with isosorbide dinitrate have a role to play in the treatment of heart failure with reduced ejection fraction...
December 11, 2018: Drugs & Aging
Francisco J Pastor-Pérez, Arcadio García-Alberola, Marina Navarro-Peñalver, Rebeca Goya-Esteban, Iris P Garrido-Bravo, Oscar Barquero-Pérez, Jose Luis Rojo-Álvarez, Domingo A Pascual-Figal
Autonomic regulation plays a role in the progression of heart failure with reduced ejection fraction (HrEF).Twenty-one HFrEF patients, 60.8 ± 13.1 years, receiving angiotensin inhibition, were replaced by angiotensin receptor-neprilysin inhibitor (ARNI). A 24-hour Holter recording was performed before and after 3 months of the maximum tolerated dose of ARNi. We evaluated changes in autonomic tone using heart rate variability (SDNN, rMSSD, pNN50, LF, HF, LF/HF, α1, α2), and heart rate turbulence (TO and TS)...
November 28, 2018: Journal of Electrocardiology
Sercan Okutucu, Cengiz Sabanoglu, Begum Yetis Sayin, Hakan Aksoy, Nurbanu Bursa, Ali Oto
BACKGROUND: Angiotensin receptor neprilysin inhibitor (ARNI, sacubitril/valsartan) reduces sudden death in heart failure with reduced ejection fraction (HFrEF). Corrected QT (QTc), T-wave peak to T-wave end interval (Tp-e) and Tp-e/QTc are electrocardiographic indices of ventricular repolarization heterogeneity. We aimed to assess the effects of switching from ramipril to ARNI on electrocardiographic indices of ventricular repolarization. METHODS: A total of 48 patients with HFrEF (mean age: 63...
December 4, 2018: Acta Cardiologica
Pierre Vladimir Ennezat, Thierry Le Jemtel, Shona Cosgrove, Jesper Hallas, Morten Rix Hansen
BACKGROUND: The impact of randomised controlled trials (RCTs) depends heavily on the presentation of the findings. OBJECTIVE: Classically, RCT findings are presented in the form of absolute risk reduction (ARR), number needed to treat (NNT) to prevent one adverse outcome, and relative risk reduction (RRR) or hazard ratio (the most favourable means for drug marketing). However, the estimation of average survival gain (i.e. outcome postponement between a trial intervention and comparator) is an alternative and informative means of presenting the findings of RCTs...
December 4, 2018: Acta Cardiologica
Jonathan P Mochel, Chi Hse Teng, Mathieu Peyrou, Jerome Giraudel, Meindert Danhof, Dean F Rigel
Simultaneous blockade of angiotensin receptors and enhancement of natriuretic peptides (NP) by the first-in-class angiotensin receptor neprilysin (NEP) inhibitor sacubitril/valsartan constitutes an effective approach to treating heart failure. This study examined the effects of sacubitril/valsartan (225 and 675 mg/day) vs. placebo, sacubitril (360 mg/day), valsartan (900 mg/day), and benazepril (5 mg/day) on the dynamics of the renin-angiotensin-aldosterone system (RAAS) and the NP system in dogs. Beagle dogs (n = 18) were fed a low-salt diet (0...
February 1, 2019: European Journal of Pharmaceutical Sciences
Pratyaksh K Srivastava, Brian L Claggett, Scott D Solomon, John J V McMurray, Milton Packer, Michael R Zile, Akshay S Desai, Jean L Rouleau, Karl Swedberg, Gregg C Fonarow
Importance: The addition of neprilysin inhibition to standard therapy, including a renin-angiotensin system blocker, has been demonstrated to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF) compared with standard therapy alone. The long-term absolute risk reduction from angiotensin receptor neprilysin inhibitor (ARNI) therapy, and whether it merits widespread use among diverse subpopulations, has not been well described. Objective: To calculate estimated 5-year number needed to treat (NNT) values overall and for different subpopulations for the Prospective Comparison of ARNI with Angiotensin-Converting Enzyme Inhibitor (ACEI) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) cohort...
November 28, 2018: JAMA Cardiology
Kelsie E Oatmen, Michael R Zile, John C Burnett, Francis G Spinale
Importance: The standard pharmacotherapy for heart failure (HF), particularly HF with reduced ejection fraction (HFrEF), is primarily through the use of receptor antagonists, notably inhibition of the renin-angiotensin system by either angiotensin-converting enzyme inhibition or angiotensin II receptor blockade (ARB). However, the completed Prospective Comparison of ARNI With an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial identified that the use of a single molecule (sacubitril/valsartan), which is an ARB and the neutral endopeptidase inhibitor (NEPi) neprilysin, yielded improved clinical outcomes in HFrEF compared with angiotensin-converting enzyme inhibition alone...
November 28, 2018: JAMA Cardiology
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