From the Guidelines
Entresto is given to patients with heart failure with reduced ejection fraction (HFrEF) to improve heart function and reduce hospitalizations and mortality. This medication combines sacubitril (a neprilysin inhibitor) and valsartan (an angiotensin receptor blocker) to improve heart function and reduce hospitalizations and mortality in patients with heart failure, as recommended by the 2024 ESC guidelines for the management of chronic coronary syndromes 1. The typical starting dose is 24/26 mg twice daily, which can be titrated up to 97/103 mg twice daily as tolerated. Patients should be monitored for hypotension, kidney function changes, and hyperkalemia. Before starting Entresto, ACE inhibitors should be discontinued at least 36 hours prior to avoid angioedema risk, as stated in the 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure 1. Entresto works by simultaneously blocking the harmful effects of angiotensin II while enhancing beneficial peptides that promote vasodilation, natriuresis, and reduced fibrosis. This dual mechanism provides superior outcomes compared to ACE inhibitors alone in heart failure management, as shown in the 2016 ACC/aha/hfsa focused update on new pharmacological therapy for heart failure 1. Some key points to consider when prescribing Entresto include:
- The patient should have elevated natriuretic peptides (plasma BNP ≥150 pg/mL or plasma NT-proBNP ≥600 pg/mL, or if HF hospitalization within the last 12 months, plasma BNP ≥100 pg/mL or plasma NT-proBNP ≥400 pg/mL) and able to tolerate enalapril 10 mg b.i.d. 1
- Entresto is recommended as a replacement for an ACE-I to further reduce the risk of HF hospitalization and death in ambulatory patients with HFrEF who remain symptomatic despite optimal treatment with an ACE-I, a beta-blocker and an MRA, as stated in the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 1. Patients should continue other heart failure medications like beta-blockers and diuretics while taking Entresto as part of a comprehensive treatment approach.
From the FDA Drug Label
Sacubitril and valsartan tablets are a combination of sacubitril, a neprilisin inhibitor, and valsartan, an angiotensin II receptor blocker, and is indicated: to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure and reduced ejection fraction. for the treatment of symptomatic heart failure with systemic left ventricular systolic dysfunction in pediatric patients aged one year and older.
Entresto (sacubitril and valsartan) is given to:
- Reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure and reduced ejection fraction.
- Treat symptomatic heart failure with systemic left ventricular systolic dysfunction in pediatric patients aged one year and older. 2 2
From the Research
Entresto Treatment for Heart Failure
Entresto, also known as sacubitril/valsartan, is a medication used to treat heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). The following points summarize the reasons why Entresto is given for heart failure:
- Entresto has been shown to improve left ventricular diastolic function in heart failure patients with preserved left ventricular ejection fraction and improve quality of life 3.
- The medication works through angiotensin receptor blockage via valsartan as well as neprilysin inhibition with sacubitril, providing a new milestone in managing heart failure patients 4.
- Entresto has been found to be superior to angiotensin receptor blocker (ARB) therapy in reducing the occurrence of hospitalization for worsening heart failure and cardiovascular death in patients with HFrEF 5.
- Compared to angiotensin-converting enzyme inhibitors (ACEI) or ARB, Entresto reduces heart failure hospitalizations, cardiovascular mortality, and all-cause mortality, and improves biomarkers and renal function 6.
- Entresto treatment has also been shown to demonstrate significantly lower 5-year mortality rates and greater left ventricular ejection fraction (LVEF) improvement in HFrEF patients with coexisting end-stage renal disease (ESRD) compared with candesartan or valsartan 7.
Key Benefits of Entresto
Some of the key benefits of Entresto include:
- Improved left ventricular diastolic function
- Improved quality of life
- Reduced risk of hospitalization for worsening heart failure
- Reduced risk of cardiovascular death
- Improved biomarkers and renal function
- Lower 5-year mortality rates in HFrEF patients with coexisting ESRD
Patient Populations
Entresto has been studied in various patient populations, including:
- Patients with HFrEF
- Patients with HFpEF
- Patients with coexisting ESRD
- Patients with advanced chronic kidney disease (CKD)