Tuesday, December 20, 2016

Focused update incorporating ARNI and ivabradine into the heart failure guidelines

This was recently published in JACC. It applies to heart failure stage C class II and III. It calls for substitution of ARNI for the ACEI or ARB (class I recommendation) and adding on ivabradine in patients on optimal medical therapy but in whom maximal titration of the beta blocker (to blood pressure tolerance) still leaves them with a resting heart rate of 70 or greater (class IIa recommentation). The ARNI substitution has a mortality benefit over the use of ACEI or ARB alone. The ivabradine add on reduces hospitalizations. The recommendation for both applies only to systolic dysfunction heart failure (HFrEF). According to the wording of the guideline update ARNI substitution is an alternative. That is, it, the use of ACEI and the use of ARB all carry a class I recommendation.

Links below contain the prescribing information for the currently approved ARNI and ivabradine, respectively.

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