So, your doctor has just prescribed a new medication for your heart condition called Entresto, lets find out a little about what this is.
Entresto (sacubitril/valsartan) is a medication developed to address heart failure, a relatively common condition in our community that occurs when the heart’s pumping ability falls below optimal levels. This can result in a range of symptoms including shortness of breath, fatigue, dizziness, swelling in the legs, and difficulty performing everyday activities. Combining sacubitril and valsartan, Entresto provides an effective solution, especially when initial treatments involving medications like ACE inhibitors and angiotensin receptor blockers (ARBs) prove inadequate. By enhancing cardiac function, this dual-action medication alleviates symptoms and reduces the risk of hospitalization and adverse outcomes associated with heart failure.
What is heart failure
Heart failure, a complex and chronic condition, occurs when the heart struggles to pump blood effectively, leading to an insufficient supply of oxygen and nutrients to the body’s tissues. It often develops as a result of underlying health issues such as coronary artery disease, high blood pressure, or heart valve disorders. There are two main types of heart failure: systolic and diastolic. Systolic heart failure, also known as heart failure with reduced ejection fraction (HFrEF), happens when the heart’s pumping ability weakens, causing reduced ejection fraction or the amount of blood pumped out with each heartbeat. Diastolic heart failure, also referred to as heart failure with preserved ejection fraction (HFpEF), occurs when the heart’s muscular walls become stiff and less able to relax during the filling phase, leading to impaired blood flow. Both types present with similar symptoms like fatigue, shortness of breath, and fluid retention, yet they require tailored approaches to management. Consulting a healthcare provider for an accurate diagnosis and appropriate treatment strategy is essential in effectively addressing heart failure and its specific type.
General principles of heart failure managment
Heart failure management follows a comprehensive approach aimed at improving patients’ quality of life and reducing hospitalizations. Lifestyle modifications play a pivotal role, including maintaining a heart-healthy diet low in sodium and saturated fats, managing fluid intake, and engaging in regular physical activity as tolerated. Medication adherence is crucial, with treatments like ACE inhibitors, beta-blockers, and diuretics commonly prescribed to optimize heart function and alleviate symptoms. Monitoring weight fluctuations and recognizing early signs of worsening symptoms are vital to prevent exacerbations. Collaborating closely with healthcare professionals to fine-tune treatment plans, attending regular follow-up appointments, and staying informed about heart failure can empower individuals to actively manage their condition and lead more fulfilling lives.
What is Entresto (sacubutril/valsartan)
Entresto (sacubitril/valsartan) is a medication specifically designed to address heart failure. It combines two types of medicines: sacubitril and valsartan. Sacubitril is an inhibitor of neprilysin (an enzyme that breaks down certain hormones), while valsartan is an angiotensin receptor blocker (ARB) that is often used to treat high blood pressure and on its own, as an initial treatment for heart failure.
The active components of Entresto, sacubitril and valsartan, function in distinct ways. Sacubitril inhibits the breakdown of natriuretic peptides, which leads to reduced strain on the heart by promoting the excretion of sodium and water in the urine. This action also decreases blood pressure and safeguards the heart from developing fibrosis—scar tissue that arises in heart failure. Valsartan, an ‘angiotensin-II-receptor antagonist’, hinders the effects of a hormone called angiotensin II. By blocking the receptors where angiotensin II normally attaches, valsartan prevents the hormone’s harmful effects on the heart and also facilitates blood vessel dilation, thus reducing blood pressure.
Entresto dosing and administration
Entresto is available in three strengths: 24/26 mg, 49/51 mg, and 97/103 mg, signifying the sacubitril and valsartan content in each tablet. This medication is often considered after initial therapies with ACE inhibitors (ACEIs) and ARBs prove inadequate in addressing heart failure. Importantly, Entresto should not be combined with ACE inhibitors, as there must be a washout period before transitioning from an ACE inhibitor to Entresto. This precaution is essential to avoid the risk of increased angioedema—a rare but serious side effect. Your healthcare provider will guide you through the transition process to ensure your safety and effective management of your heart condition.
Entresto is taken twice a day in the form of tablets. Similar to many medications, the treatment typically commences with a lower dosage to ensure its effectiveness and your comfort. Over the course of a few weeks, the dosage can be gradually increased while closely observing how your body responds, any symptoms you may experience, your blood pressure levels, and the results of blood tests assessing kidney function. This cautious approach ensures that the medication suits you well and achieves the desired outcomes.
Evidence for Entresto in heart failure
In a primary study, Entresto demonstrated its effectiveness in treating heart failure among adults. This study involved a comparison between Entresto and enalapril, another medication used for heart failure. The participants in the study had long-standing heart failure accompanied by symptoms of the condition and reduced ejection fraction (the portion of blood leaving the heart). Among those treated with Entresto, 21.8% (914 out of 4,187) of patients either experienced heart and circulation-related complications or were hospitalized due to heart failure. In contrast, 26.5% (1,117 out of 4,212) of patients treated with enalapril faced similar issues. The study spanned approximately 27 months, during which the participants took the medication for an average of around 24 months. The study was concluded prematurely due to compelling evidence indicating that Entresto was more effective than enalapril in these aspects.
|Sacubitril/valsartan 97/103 mg twice daily||Enalapril 10 mg twice daily|
|Composite primary outcome: death from cardiovascular causes or hospitalization from worsening heart failure||21.8% (914/4187)||26.5% (1117/4212)|
|Death from cardiovascular causes||13.3% (558/4187)||16.5% (693/4212)|
|Hospitalization from worsening heart failure||12.8% (537/4187)||15.6% (658/4212)|
Table – Efficacy of sacubitril/valsartan compared to enalapril in chronic heart failure. The PARADIGM-HF trial (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) was a landmark clinical trial that brought significant insights into heart failure management. This trial focused on comparing the effects of a novel medication, Entresto (sacubitril/valsartan), with the traditional ACE inhibitor enalapril in patients with heart failure and reduced ejection fraction (HFrEF).
The trial’s results demonstrated that Entresto was more effective than enalapril in reducing the risk of cardiovascular death and hospitalization due to heart failure. This pivotal finding led to the early termination of the study, highlighting the clear advantage of Entresto over the standard ACE inhibitor treatment.
Side effects and precautions
This figure illustrates a chest X-ray (CXR) showcasing characteristic findings of heart failure-associated pulmonary edema. The CXR exhibits prominent bilateral opacities in the lung fields, resembling the wings of a bat. These opacities indicate the accumulation of fluid within the lung tissues, a hallmark of congestive heart failure. The bat wings appearance results from fluid overload causing increased interstitial and alveolar fluid, leading to widespread haziness in the lung fields.
In summary, Entresto (sacubitril/valsartan) represents a significant advancement in heart failure treatment. This medication combines sacubitril and valsartan to effectively address heart failure complexities, enhancing cardiac function, easing symptoms, and reducing hospitalization risks. Supported by robust clinical evidence, Entresto exemplifies medical progress, offering a pragmatic approach to improve the well-being and longevity of individuals grappling with heart failure. Heart failure management remains multifaceted, underscoring the importance of lifestyle monitoring such as regular weight checks and medication adherence. Your healthcare provider can offer tailored guidance on integrating Entresto into your heart health strategy.