Pharmacotherapeutics of sacubitril/valsartan: an overview for nurses

Introduction: The global prevalence of heart failure is increasing, with significant implications for healthcare resources and many patients’ quality of life. International guidelines recommend that sacubitril/valsartan may be initiated in patients with heart failure and a reduced ejection fraction as first-line therapy. However, the National Institute for Health and Care Excellence, the governing body in the UK, advises prescription of an angiotensin converting enzyme inhibitor or angiotensin receptor blocker before switching to sacubitril/valsartan. This combination drug is the first angiotensin-receptor neprilysin inhibitor, approved for use in the UK in 2016. It is imperative that nurses and other healthcare professionals involved in heart failure management have thorough knowledge of the drug and its effects. Aims and Objectives: This article briefly examines the pathophysiology of heart failure and critiques the pharmacotherapeutics of both components of the angiotensin receptor neprilysin inhibitor, sacubitril and valsartan, independently in heart failure with reduced ejection fraction treatment. Discussion: Through an evaluation of the evidence underpinning the use of sacubitril/ valsartan in clinical practice, implications for both healthcare professionals and patients when commencing an angiotensin-receptor neprilysin inhibitor are highlighted. Conclusions: The need for a multidisciplinary approach to heart failure management is outlined. Despite the proven efficacy of prescribing the angiotensin receptor neprilysin inhibitor for this patient cohort, further study is needed to evaluate the long-term effects of this drug.