Latest Drugs for Systolic Heart Failure

You’ll hear buzz about when to use Entresto (sacubitril/valsartan) or Lancora in Canada /Cornalor in USA (ivabradine) for systolic heart failure.

Recent guidelines highlight the role of these meds in systolic heart failure…now called heart failure with reduced ejection fraction (HFrEF).

But expect to see these meds saved for specific situations.

Continue to recommend an ACEI or ARB plus an “evidence-based” beta-blocker…carvedilol or bisoprolol. Advise adding an aldosterone antagonist (spironolactone, etc) if symptoms persist.

If that’s not enough, consider whether a new med is appropriate.

Consider suggesting Entresto as a REPLACEMENT for an ACEI or ARB…usually in patients with a recent heart failure hospitalization while on target doses of an ACEI or ARB, beta-blocker, and aldosterone antagonist.

This “angiotensin receptor-neprilysin inhibitor” (ARNI) has an edge over ACEIs. It prevents one CV death or heart failure hospitalization for every 21 patients treated over 2 years versus an ACEI alone.

But Entresto causes hypotension in one in 21 patients…should be avoided in patients who’ve had angioedema…

If patients switch, advise waiting at least 36 hours after stopping an ACEI to start Entresto…to reduce the risk of angioedema.

Advise saving Lancora as an ADD-ON to standard therapy…usually in patients who don’t tolerate target beta-blocker doses due to hypotension.

Lancora/Cornalor® lowers heart rate withOUT dropping blood pressure.

It prevents hospitalization in one in 25 patients when ADDED to an ACEI or ARB, beta-blocker, and aldosterone antagonist.

But it does NOT reduce mortality. And it leads to bradycardia in one in 13 patients…and atrial fib in about one in 100 patients.

Explain Lancora is only for patients in normal sinus rhythm with a heart rate of at least 77.