Sacubitril/Valsartan in the primary treatment of heart failure with reduced ejection fraction (HFrEF)

Sacubitril/Valsartan are recommended by all guidelines worldwide as the primary drug treatment of heart failure with reduced ejection fraction (HFrEF), without compulsory prior treatment with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB). The simultaneous combination of Sacubitril/Valsartan together with beta blockers, mineralocorticoid receptor antagonists and sodium-glucose transporter 2 (SGLT2) inhibitors has replaced the previous recommendation of sequential treatment with slow up-titration to the maximum tolerated dose. This article summarizes the evidence for this. This combined primary therapy with sacubitril and valsartan in HFrEF reduces the mortality and rehospitalization rates and improves the quality of life of the patients.