Put New Heart Failure Guidelines in Perspective

We’re used to “triple therapy” for HFrEF...an ACEI or ARB, evidence-based beta-blocker (carvedilol, etc), and aldosterone antagonist (spironolactone, etc)...to reduce hospitalizations and death.

Now Entresto (sacubitril/valsartan) is preferred INSTEAD of an ACEI or ARB when possible...since it prevents hospitalization or CV death in about 1 in 21 patients versus an ACEI.

Guidelines also suggest “QUAD therapy”...adding an SGLT2 inhibitor (Farxiga, etc) to triple therapy, regardless of diabetes. This prevents hospitalization or CV death in about 1 in 20 patients.