A washout period is not needed if 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.
Randomized clinical trials support the use of ARNI as de novo therapy in patients with HFrEF naive to ACEIs or ARB therapies. It is not clear, however, whether de novo ARNI initiation is best for all patients with HFrEF, including those with hypotension (SBP < 90 mm Hg) or very advanced disease (New York Heart Association functional class IV symptoms). Established use of an aldosterone antagonist is not required before initiating an ARNI. Close follow-up and serial assessments (blood pressure, electrolytes, and renal function) should be considered when de novo initiation of an ARNI is performed, and the risk for angioedema or hypotension should be considered as well.
Learn more about the role of ARNIS in the treatment of HFrEF.
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Cite this: Alanna Morris. Fast Five Quiz: Heart Failure With Reduced Ejection Fraction (HFrEF) Treatment Optimization - Medscape - Sep 09, 2021.