ACEi to ARNi: “The Switch” An Evidence Based Review

Abstract

Heart failure affects approximately 6.5 million adults in the United States, and the cost to healthcare system is tremendous [1]. Effective treatment for this very important disease is constantly evolving. The most signifi cant change in the recent past has been the development of ARNI (Sacubitril/ Valsartan) for treatment of heart failure [2]. Recently ACC, AHA and HFSA, have recommended switching NYHA class II or class III patients to ARNI from ACE-I or ARB if they are symptomatic, (Class I recommendation) giving it level of evidence B-R. (Moderate quality evidence from 1 or more RCTs, or Moderate quality meta-analysis) [3].