What is the feasibility of initiating ARNI during an acute decompensated HF hospitalization?
The PIONEER-HF (Comparison of Sacubitril Valsartan versus Enalapril on Effect on NT-proBNP in Patients Stabilized from an Acute HF Episode) trial established that the initiation of ARNI during an acute decompensated HF hospitalization is feasible (23) after the patient has been hemodynamically stabilized; in PIONEER-HF, up to 25% of patients developed hypotension when treated with sacubitril/valsartan. Therefore, ensuring patients are not volume-depleted at the time of initiation may help to avoid this issue. Notably, the TRANSITION (Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event) study demonstrated that about one-half of the patients could achieve the target dose within 10 weeks after in-hospital initiation or soon after discharge (24).