Summary

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• Sacubitril and valsartan (Entresto) is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure, particularly those with left ventricular ejection fraction (LVEF) below normal.
• The information was derived from 30 systematic reviews/meta-analyses.
• In comparison to ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), sacubitril/valsartan significantly reduces all-cause mortality and hospitalization risks in patients with Heart Failure with Reduced Ejection Fraction (HFrEF).
• For Heart Failure with Preserved Ejection Fraction (HFpEF), Entresto shows a reduction in hospitalizations but does not significantly impact overall mortality compared to ACEIs/ARBs.
• Sacubitril/valsartan contributes positively by preventing renal function decline, especially in HFpEF patients, showing reduced incidence of composite renal impairment compared to RAAS inhibitors.
• Post-Acute Myocardial Infarction benefits include reduced heart failure hospitalization rates and improved LV ejection fraction without significant reductions in cardiovascular mortality or recurrence of myocardial infarction.
• Frequently reported adverse effects include hypotension; however, it does not show a higher risk of hyperkalemia or worsening renal function compared to other neuroendocrine inhibitors like ACEIs/ARBs.
• Subpopulation analysis indicates greater efficacy for symptomatic HFrEF patients classified as NYHA class II/III, older adults, diabetic individuals, those with elevated NT-proBNP levels, and complex heart failure cases among elderly populations.