Evidence of superiority of sacubitril/valsartan versus angiotensin-converting enzyme inhibitors or angiotensin ii receptor blockers in the heart failure with reduced ejection fraction patient's journey

Sacubitril/valsartan (S/V) is a new drug which has been recently recommended by the international guidelines for the treatment of patients with chronic heart failure (HF) with reduced ejection fraction (HFrEF). Compared to angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs), S/V is associated with a better cardiovascular outcome, and to a greater beneficial effect on myocardial reverse remodeling. Recent evidence has shown that S/V is not only recommended in chronic patients but it is also approved in the acute setting; moreover, its safety and tolerability have been demonstrated also in the pediatric population. This review summarizes data on the effectiveness and tolerability of S/V in HFrEF patients and offers practical insights to manage this drug in every setting, providing an overview from randomized clinical trials' data to real-world evidence.