From the Guidelines
Sacubitril/valsartan is more effective than losartan and carvedilol for heart failure, as it reduces the composite endpoint of cardiovascular death or heart failure hospitalization by 20%. This is based on the most recent and highest quality study available, which compared an ARNI (valsartan/sacubitril) with an ACE inhibitor (enalapril) in symptomatic patients with HFrEF 1. The benefits of sacubitril/valsartan were seen to a similar extent for both death and heart failure hospitalization and were consistent across subgroups.
Key Points
- Sacubitril/valsartan is a neprilysin inhibitor that has been shown to reduce mortality and morbidity in patients with heart failure 1.
- Losartan is an angiotensin II receptor blocker that helps block the renin-angiotensin system, reducing blood pressure and cardiac workload, but its benefit on mortality is modest (5-16% risk reduction) 1.
- Carvedilol is a beta-blocker that has been shown to prolong life and reduce the risk of sudden death, but its benefit is also modest compared to sacubitril/valsartan 1.
- The use of sacubitril/valsartan in replacement of ACE inhibitor or ARB therapy is supported by additional clinical trial evidence, meta-analyses, and observational clinical effectiveness studies 1.
Treatment Considerations
- Heart failure treatment should always be guided by a cardiologist using evidence-based medications like ACE inhibitors/ARBs, beta-blockers, mineralocorticoid receptor antagonists, and newer agents like SGLT2 inhibitors depending on the specific type of heart failure and patient characteristics.
- Sacubitril/valsartan should be considered as a first-line treatment for patients with heart failure, given its superior efficacy compared to losartan and carvedilol.