When should I start Entresto?

Written by John Steuter, MD

When a patient is hospitalized for heart failure (HF), it is a sentinel moment for many reasons, one of which is that their risk for subsequent events is significantly higher. Also, following hospitalization, patients are much more willing to accept changes in their medical regimen, including aggressive titration of medication or addition of new therapies. 

Former Heart Failure Studies

The PARADIGM-HF trial, which was the pivotal study for sacubitril/valsartan (Entresto), excluded patients with acute decompensated HF, so the effect of the drug on those patients was not confirmed and a trial in that population was needed. 

Therefore, PIONEER-HF was undertaken to give the medical community greater insight into the safety of sacubitril/valsartan versus a standard heart failure medicine in this vulnerable time period. The outlook for patients in first 30 days following HF hospitalization is poor, with up to one in five readmitted during this vulnerable period and up to 10% mortality risk.

New Results: PIONEER-HF Trial

At the recent AHA meeting in November the PIONEER-HF trial results were released.

Patients with acute decompensated heart failure had greater reduction in N-terminal pro-B-type natriuretic peptide when assigned sacubitril/valsartan (Entresto) than treatment with enalapril.

Sacubitril/valsartan (Entresto) was also superior to enalapril for a secondary serious composite clinical endpoint of death, HF rehospitalization, left ventricular assist device implantation or transplant listing at eight weeks.

The two treatments did not differ in the safety endpoints of:

• Worsening renal function
• Hyperkalemia
• Symptomatic hypotension
• Angioedema

Sacubitril/valsartan (Entresto) has a class I indication for treatment of symptomatic heart failure with reduced ejection fraction (HFrEF) in the AHA/American College of Cardiology guidelines and should be utilized when possible in treating heart failure patients.

The recent results from PIONEER-HF help to build the body of evidence about the benefit and safety of Entresto therapy.

Bryan Heart: A Leader in Heart Failure Treatment

For more information about leading edge heart failure treatment or to refer a patient, contact Bryan Heart at 402-483-3333.