Evidence-based Consensus On The Use Of Sacubitril Valsartan For Heart Failure Management In India

• Published in: Journal of cardiac failure 2024-01, Vol.30 (1), p.240-240
• Main Authors: Sawhney, Jitendra, Vasudevan, Karthik, Shashikanth, T., Das, Vashisth, Raghu, K., Goyal, Naresh, Rastogi, Vishal, Shrivastava, Sameer, Singh, Balbir, Mehta, Ashwani, Suresh, PV, Ranjit, G., Kumar, Manoj, Jain, Priyank, Pandey, Anand
• Format: Article
• Language: English
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2023.10.293

The PARADIGM-HF trial in 2014 established sacubitril/valsartan (SV) as an effective treatment for heart failure (HF). Recent trials support expanding its use and guidelines recommend its use. A consensus statement is being formulated to validate the contemporary evidence-based datasets for SV in managing HF and exploring its pleiotropic effects A group of 57 leading cardiologists (VICTORY Study group) with extensive clinical experience, cumulative 1700 man hours convened in January 2023 to discuss and rate their level of agreement on 11 questions related to heart failure care, using a 5-point Likert scale. Consensus was pre-defined as a score > 100. GraphPad 9.4.0 and ANOVA were used for statistical analysis The highest agreement score in the decreasing rank order (of the weighted mean score), was for that; evidence from landmark trials from ARNIs have translated benefits in the real-world setting (128), uniform agreement for the principle of fantastic four drugs in HFrEF management (127.6), based on the very heterogeneous characteristics in patients with HFpEF, there is strong need to identify markers, aside from LVEF, that could potentially predict responsiveness to the therapies (123), use of additional criteria beyond LVEF for characterization may improve prediction of patient response to sacubitril/valsartan and other therapies (122.8), NT-proBNP has prognostic value independent of HF therapy and NT-proBNP baseline levels (119.1), economical ARNI would help address therapeutic inertia and provide accelerated patient benefits (116.1), biomarkers are helpful identify subsets of patients who might benefit from sacubitril/valsartan, regardless of LVEF (110), and attention should be warranted to low dose 25 mg dose in a real practice (108.5) (Table). The long-term implications (by 2030) of usage of ARNI was postulated to be for the improvement in quality of life, followed by overall decrease in mortality, improvement in the costs of care and improvement in patient satisfaction. The adjusted mean response scores (±SD, 95% CI) for consensus were for agree (58±24, 95% CI 42 to 74) followed by strongly agree (46±35, 95% CI 23 to 70), neither agree nor disagree (11±15, 95% CI 0.72 to 21), disagree (-6.4±8.7, 95% CI -12 to -0.55) The patient-centric outcomes of ARNI clinical trials are being effectively implemented in real-world practice, but there is a need for better prognostic biomarkers to understand the progression of heart failure in patients on ARNI. ARNI