HFrEF is a separate entity in heart failure as per the recent classification of heart failure. HFpEF is another entity. I started using ARNI drug namely containing Sacubitril and Valsartan in which Sacubitril is a Neprilysin inhibitor. Valsartan is an ARB. As per the protocol, one needs to stop the ACE inhibitor if the patient is taking, for 36 hours and then start on this combination. Most of my patients around 10 were taking diuretics only.
I stop diuretics overnight and start on Sacubitril and Valsartan next day morning. As per the literature, one needs to stop ACE inhibitor and can reduce the diuretics. The advantage of Sacubitril and Valsartan is reduced usage of diuretics. But in my study to my surprise except for one patient all patients have stopped diuretics and with this drug combination, they are doing fine. It is a breakthrough in Cardiology because one cannot imagine that…
