Expert perspectives on the use of sacubitril/valsartan for managing heart failure in Indian settings

Objective: To assess clinicians' views on the management of heart failure (HF) in India, with a particular focus on the clinical use and prescription pattern of sacubitril/valsartan therapy in outpatient settings. Methodology: This cross-sectional study was conducted among Indian clinicians and used a 23-item questionnaire on HF prevalence, comorbidities, and the clinical use and prescribing patterns of sacubitril/valsartan. Data were analyzed using descriptive statistics, with results presented as percentages and visualized through pie and bar charts. Results: This study involved 163 clinical experts, and approximately 41% of them identified diabetes mellitus (DM) as the most common comorbid condition in HF patients. About 69% of clinicians preferred angiotensin receptor-neprilysin inhibitor (ARNi) therapy with sacubitril/valsartan for HF management, while 31% reported angiotensin-converting enzyme inhibitors (ACEi) as the most commonly used RAAS-modifying therapy. Nearly 92% of experts preferred the 100 mg dose of sacubitril in routine practice. Over 63% noted that ARNi’s dual action on RAAS and neuropeptide S (NPS) pathways reduces mortality, and 56% highlighted a reduction in hospitalizations. Around 40% of the clinicians favored metoprolol as the preferred beta-blocker, and 95% reported dapagliflozin as the most prescribed sodium-glucose co-transporter 2 (SGLT2) inhibitor in clinical practice for HF patients. Conclusion: The study highlights ARNi (sacubitril/valsartan) as the preferred first-line therapy, with metoprolol and dapagliflozin commonly used for HF management. The dual action of ARNi on RAAS and NPS pathways is recognized for reducing mortality and hospitalizations, emphasizing the importance of personalized, evidence-based care.