From the Research
The decision to hold Entresto (sacubitril/valsartan) in a patient with an episode of tachycardia should be individualized based on the patient's clinical status, with consideration of the potential benefits of continued therapy on morbidity, mortality, and quality of life, as supported by recent studies such as 1 and 2.
Key Considerations
- Entresto does not need to be routinely held for isolated episodes of tachycardia unless the patient is hemodynamically unstable or the tachycardia is symptomatic and concerning, as suggested by the overall clinical context and studies like 3 and 4.
- If the tachycardia is causing hypotension (systolic blood pressure below 90 mmHg), significant symptoms, or hemodynamic compromise, temporarily holding Entresto would be reasonable until the patient stabilizes, considering its vasodilatory effects.
- The importance of identifying and addressing the underlying cause of the tachycardia rather than simply discontinuing a medication that provides mortality benefit in heart failure is highlighted by studies such as 5, which discuss the efficacy of sacubitril/valsartan in various patient populations.
Clinical Approach
- Once the tachycardia resolves and the patient is stable, Entresto can typically be resumed at the previous dose, given its established benefits in reducing morbidity and mortality in heart failure patients, as demonstrated in studies like 1.
- If tachycardia episodes are recurrent, consultation with a cardiologist would be appropriate to evaluate the patient's heart failure management strategy and determine if any adjustments to the medication regimen are needed, taking into account the latest evidence and guidelines.
Evidence Summary
- Recent studies, including 1 and 2, support the use of sacubitril/valsartan in a wide spectrum of heart failure patients, highlighting its benefits in reducing clinical outcomes and improving quality of life.
- The safety and efficacy of sacubitril/valsartan have been demonstrated in various populations, including those with reduced ejection fraction, as shown in studies like 3 and 4.
- Ongoing research, such as the study in 2, continues to explore the prognostic significance of different parameters in patients undergoing ARNI therapy, further informing clinical decision-making.