Indian Consensus on the Role and Position of Angiotensin Receptor-neprilysin Inhibitors in the Management of Heart Failure

The incidence of heart failure (HF) in India is estimated to be 0.5-1.7 cases per 1,000 people per year, and approximately 4,92,000-1.8 million new cases are detected every year. Despite the high rate of mortality associated with HF, most patients do not receive maximal guideline-directed medical therapy (GDMT). Current guidelines advocate early multidrug combination therapy with four classes of drugs, namely, beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium-glucose transport protein 2 inhibitors (SGLT-2is), particularly in patients with heart failure with reduced ejection fraction (HFrEF). ARNIs reduce cardiac morbidity and mortality in patients with HFrEF. However, recent data indicated that only 4.8% of patients with HFrEF receive ARNI in India. Hence, at a national consensus on HF meeting, cardiology experts from India formulated a national consensus on the use of ARNI in HF based on current evidence and guidelines. The consensus states that ARNI should be used early in HF, particularly in de novo patients with HFrEF, and those with acute decompensated heart failure (ADHF), irrespective of the presence of low systolic blood pressure (SBP) or diabetes. Moreover, those with HFrEF on renin-angiotensin-aldosterone system (RAAS) inhibitors should be switched to ARNI to reduce the risk of repeated hospitalization for HF, worsening HF, and cardiac death, and to improve the quality of life (QoL). Starting ARNI during the first hospitalization is preferable, and it is safe and effective across all doses. ARNIs can also be used for secondary benefits in patients with preserved ejection fraction [heart failure with preserved ejection fraction (HFpEF)] and HF with mildly reduced EF [heart failure with mildly reduced ejection fraction (HFmrEF)].

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Journal
Journal of the Association of Physicians of India
Published
2024-09-01
DOI
https://doi.org/10.59556/japi.72.0664
Primary Topic
Heart Failure Treatment and Management
Type
article
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article

Indian Consensus on the Role and Position of Angiotensin Receptor-neprilysin Inhibitors in the Management of Heart Failure

Sanjay Mittal, Jagat Narula, Vinod Kumar Mittal, Prabhakar Dorairaj et al.
Journal of the Association of Physicians of India
Heart Failure Treatment and Management
article

Indian Consensus on the Role and Position of Angiotensin Receptor-neprilysin Inhibitors in the Management of Heart Failure

Sanjay Mittal, Jagat Narula, Vinod Kumar Mittal, Prabhakar Dorairaj, Saseendar Shanmugasundaram, Arvind K. Pancholia, Manish Jagia, MANGESH HARIHAR TIWASKAR, Tiny Nair, Onkar C Swami, G. Justin Paul, Blessy Sehgal, Anand Pandey, Manish Bansal, Arvind Sinha, Chandrashekhar K. Ponde, Sanjay Jain, Gurpreet Singh Wander, Shishu Mishra, Namrata Gaur, Sarita Rao, Ameet Sattur, Kiran Mahmood, Ripen Gupta, Samir Kubba, Ramesh Hotchandani, Dinesh Khullar, Vijay Kher, Sandeep Bansal, Shalini Jaggi, Sunil Prakash, Devinder Singh Rana, Naresh Goel, Harmeet Singh, Rajeev Chawla, Rajeeve Rajput, Asha Moorthy, Aparna Jaswal, V K Katyal, Poonam Malhotra, Ashok K Omar, R.R. Mantri, Rekha Mishra, Dilip Bhalla, Vishal Rastogi, Saurabh Bagga, Rohit Tandon, Vivudh Pratap Singh, Hriday Kumar Chopra, Navin C. Nanda, Sheeba George, Prasant Kumar Sahoo, Saumitra Ray, Priyank Shah, Abhinav Chhabra, Kiron Varghaese, Vittul Gupta, Aditya Kapoor, Nagendra Chauhan, Shamsad Alam, Dharmender Jain, Alok Sehgal, R. D. Passey, Jitendrapal Singh Sawhney, Rahul Mehrotra, Mohan Bhargava, Praful Kerkar, Subhash Chandra, Ravi R. Kasliwal, Anupam Goel, Praveen Chandra, Ashok Kirpalani, Surabhi Awasthi, Jabir Abdullakutty, I B Vijayalakshmi, Yatin Mehta, Satyendra Tiwari, Satya Narayan Routray, Rajnikant N Shastry, Viveka Kumar
article en

Abstract

The incidence of heart failure (HF) in India is estimated to be 0.5-1.7 cases per 1,000 people per year, and approximately 4,92,000-1.8 million new cases are detected every year. Despite the high rate of mortality associated with HF, most patients do not receive maximal guideline-directed medical therapy (GDMT). Current guidelines advocate early multidrug combination therapy with four classes of drugs, namely, beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium-glucose transport protein 2 inhibitors (SGLT-2is), particularly in patients with heart failure with reduced ejection fraction (HFrEF). ARNIs reduce cardiac morbidity and mortality in patients with HFrEF. However, recent data indicated that only 4.8% of patients with HFrEF receive ARNI in India. Hence, at a national consensus on HF meeting, cardiology experts from India formulated a national consensus on the use of ARNI in HF based on current evidence and guidelines. The consensus states that ARNI should be used early in HF, particularly in de novo patients with HFrEF, and those with acute decompensated heart failure (ADHF), irrespective of the presence of low systolic blood pressure (SBP) or diabetes. Moreover, those with HFrEF on renin-angiotensin-aldosterone system (RAAS) inhibitors should be switched to ARNI to reduce the risk of repeated hospitalization for HF, worsening HF, and cardiac death, and to improve the quality of life (QoL). Starting ARNI during the first hospitalization is preferable, and it is safe and effective across all doses. ARNIs can also be used for secondary benefits in patients with preserved ejection fraction [heart failure with preserved ejection fraction (HFpEF)] and HF with mildly reduced EF [heart failure with mildly reduced ejection fraction (HFmrEF)].

Journal of the Association of Physicians of IndiaVol. 72(9)
Apollo Hospitals (IN), Shilpa (India) (IN)
Good health and well-being
Openalex Percentile: Top 72%
Heart Failure Treatment and Management
DOISourceOpenAlex
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