An update to the 2013 ACCF/AHA Guideline for the Management of Heart Failure was recently released to reflect the addition of two new pharmacotherapeutic options in the treatment of heart failure: valsartan/sacubitril, an angiotensin receptor-neprilysin inhibitor (ARNI) and ivabradine, a sinoatrial node modulator. The update clarifies that patients with chronic symptomatic HF with reduced ejection fraction should be given a regimen consisting of an ACE inhibitor or ARB or ARNI along with a beta blocker and an aldosterone antagonist. ARNIs should replace ACE inhibitors or ARBs when stable patients with mild-to-moderate HF on those therapies have an adequate blood pressure and are otherwise tolerating standard therapies well. According to Clyde W. Yancy, MD, MSc, MACC, who chaired the writing committee, “Not every patient is a good candidate for every drug; these guidelines can help physicians decide who best fits which treatment. This document details the benefits and risks of these new therapies so that patients at high risk can be directed towards alternative therapies.”
2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: an Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2016; doi:10.1016/j.jacc.2016.05.011.