Expert Opinion on the Clinical Use of Angiotensin Receptor-Neprilysin Inhibitors in the Management of Heart Failure in Real-World Indian Settings

Background: Though there are several studies shown the efcacy of sacubitril/valsartan in patients with HFrEF, there is a dearth of studies among clinicians. To gather expert opinion on the use of angiotensin receptor-n Objective: eprilysin inhibitor (ARNI) therapy in managing heart failure (HF) patients in real-world Indian settings. Methodology: The cross-sectional study utilized an 18-item, multiple-response questionnaire to gather expert opinion from cardiologists in managing HF. The survey encompassed questions about current prescription practices, clinical observations, preferences, and experiences related to the use of ARNI in routine settings for HF management. The data were analyzed using descriptive statistics. Results: More than half (66.67%) of the clinicians expressed a preference for the ARNI (sacubitril/valsartan) drug class for managing HF. Nearly 66% of the respondents noted that the dual action of ARNI on the reninangiotensin-aldosterone system and natriuretic peptides (RAAS & NPs) pathway results in better outcomes with reduced mortality rates. Approximately 34% of clinicians highlighted cardiac remodeling as a distinct advantage of ARNI over other available drugs, while another 33% emphasized additional benets such as biomarker improvement, reduced hospitalization, and disease progression. Majority (84.78%) of the clinicians concurred with the ndings of the PIONEER-HF study, indicating that early initiation of ARNI in acute HF leads to early improvement in post-discharge outcomes. Additionally, most clinicians (89.13%) reported that sacubitril/valsartan 100 mg (49/51 mg) was commonly used for HF management. he study revealed a strong preference among clinicians for ARNI in HF management, and Conclusion: T the widespread use of sacubitril/valsartan 100 mg (49/51 mg). It highlighted the dual action of ARNI on the RAAS and NPs pathway, leading to improved outcomes as well as the importance of early ARNI initiation in acute HF.