Fast Five Quiz: Heart Failure With Reduced Ejection Fraction (HFrEF) Treatment Optimization

Alanna Morris, MD; Michael Weber, MD; Jeffrey J. Hsu, MD


March 13, 2023

A washout period is not needed when switching from an ARB to an ARNI, but a 36-hour waiting period is required before initiating an ARNI in patients who were previously on an ACEI to reduce the risk for angioedema. Thus, use of an ACEI within the past 36 hours is an absolute contraindication to ARNI. Other contraindications to ARNI include prior angioedema with ACEI or ARB, prior hypersensitivity to ARB, severe hepatic impairment, pregnancy, and diabetes being treated with aliskiren.

Randomized clinical trials support the use of ARNI as de novo therapy in any patient naive to ACEIs or ARB therapies with HFrEF New York Heart Association class II or III symptoms.

Established use of an aldosterone antagonist is not required before initiating an ARNI. However, close follow-up and serial assessments with blood pressure, electrolytes, and renal function should be performed after initiation of an ARNI.

Learn more about the role of ARNIs in the treatment of HFrEF.


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