Indian Consensus on the Role and Position of Angiotensin Receptor-neprilysin Inhibitors in the Management of Heart Failure.
Satyendra Tiwari, Rajeev Passey, Shamsad Alam, Ashok Kumar Omar, Satya Narayan Routray, Shishu Shankar Mishra, Vittul Gupta, S Shanmugasundaram, Nagendra Chauhan, Praful Kerkar, Rajeeve Rajput, Jitendrapal Singh Sawhney, Hriday Kumar Chopra, Prasant Kumar Sahoo, Devinder Singh Rana, Blessy Sehgal, Rohit Tandon, V K Katyal, Ramesh Hotchandani, Ajay Sinha, Surabhi Awasthi, Rajnikant N Shastry, Saurabh Bagga, Abhinav Chhabra, Samir Kubba, Ripen Gupta, Naresh Goel, Alok Sehgal, Rekha Mishra, Ameet Sattur, Asha Moorthy, Manish Jagia, Sarita Rao, Namrata Gaur, Dharmender Jain, Kiron Varghaese, Ishwarappa Balekundri Vijayalakshmi, Vivudh Pratap Singh, Prabhakar Dorairaj, Justin Paul, Poonam Malhotra, Tiny Nair, Anupam Goel, Saumitra Ray, Ashok Kirpalani, Rahul Mehrotra, Aditya Kapoor, Praveen Chandra, Harmeet Singh, Sunil Prakash, Vijay Kher, Anand Pandey, Yatin Mehta, Shalini Jaggi, Rajeev Chawla, Sanjay Mittal, Chandrashekhar Ponde, Dinesh Khullar, Jabir Abdullakutty, Sheeba George, Jagat Narula, Dilip Bhalla, Aparna Jaswal, Mohan Bhargava, Vishal Rastogi, Arvind K Pancholia, Viveka Kumar, Vinod Mittal, Gurpreet Singh Wander, R R Mantri, Priyank Shah, Onkar C Swami, Sanjay Jain, Sandeep Bansal, Navin C Nanda, Subhash Chandra, Kiran Mahmood, Mangesh Tiwaskar, Ravi R Kasliwal, Manish Bansal
Journal: The Journal of the Association of Physicians of India
2024;72(9):75-82
PMID: 39291524
Abstract
The incidence of heart failure (HF) in India is estimated to be 0.5-1.7 cases per 1,000 people per year, and approximately 4,92,000-1.8 million new cases are detected every year. Despite the high rate of mortality associated with HF, most patients do not receive maximal guideline-directed medical therapy (GDMT). Current guidelines advocate early multidrug combination therapy with four classes of drugs, namely, beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium-glucose transport protein 2 inhibitors (SGLT-2is), particularly in patients with heart failure with reduced ejection fraction (HFrEF). ARNIs reduce cardiac morbidity and mortality in patients with HFrEF. However, recent data indicated that only 4.8% of patients with HFrEF receive ARNI in India. Hence, at a national consensus on HF meeting, cardiology experts from India formulated a national consensus on the use of ARNI in HF based on current evidence and guidelines. The consensus states that ARNI should be used early in HF, particularly in de novo patients with HFrEF, and those with acute decompensated heart failure (ADHF), irrespective of the presence of low systolic blood pressure (SBP) or diabetes. Moreover, those with HFrEF on renin-angiotensin-aldosterone system (RAAS) inhibitors should be switched to ARNI to reduce the risk of repeated hospitalization for HF, worsening HF, and cardiac death, and to improve the quality of life (QoL). Starting ARNI during the first hospitalization is preferable, and it is safe and effective across all doses. ARNIs can also be used for secondary benefits in patients with preserved ejection fraction [heart failure with preserved ejection fraction (HFpEF)] and HF with mildly reduced EF [heart failure with mildly reduced ejection fraction (HFmrEF)].
© Journal of the Association of Physicians of India 2024.
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Senior Consultant, Department of Cardiology, Medanta Moolchand Heart Center, Delhi, India.; Consultant Cardiologist and Head, Department of Cardiology, P D Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India.; Professor, Department of Cardiology, Dayanand Medical College and Hospital (DMC&H), Ludhiana, Punjab, India.; Head, Department of Cardiology, PRS Hospital, Thiruvananthapuram, Kerala, India.; Director, Department of Invasive Cardiology, AMRI Hospital, Kolkata, West Bengal, India.; Chairman, Department of Nephrology and Renal Transplant Medicine, Max Super Speciality Hospital, Delhi, India.; Distinguished Professor of Medicine and Cardiovascular Disease, Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama.; Executive Vice President & Chief Academic Officer, University of Texas, Health Houston, Houston, Texas, United States.; Chairman, Department of Clinical and Preventive Cardiology, Medanta-The Medicity, Gurugram, Haryana, India.; Chairman, Department of Nephrology, Sir Ganga Ram Hospital, Delhi, India.; Consultant Nephrologist, Bombay Hospital, Mumbai, Maharashtra, India.; Chief of Clinical and Preventive Cardiology, Chairman, Department of Cardiology, Sir Ganga Ram Hospital, Delhi, India.; Chairman, Department of Interventional and Structural Heart Cardiology, Gurugram, Haryana, India.; Director, Department of Critical Care Medicine, Medanta Institute of Critical Care Anaesthesiology, Medanta-The Medicity, Gurugram, Haryana, India.; Principal Director and Chief of Cath Labs (Pan Max), Department of Cardiac Sciences, Max Hospital, Delhi, India.; Professor, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.; Head of Department, Department of Clinical and Preventive Cardiology, Arihant Hospital and Research Centre, Indore, Madhya Pradesh, India.; Chairman, Department of Nephrology, Department of Kidney Transplant, Epitome Kidney Urology Institute and Lions Hospital, Delhi, India.; Consultant in Cardiology, Professor and Head, Department of Cardiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, Delhi, India.; Vice Chairman, Clinical & Preventive Cardiology, Medanta-The Medicity, Gurugram, Haryana, India.; Senior Consultant Interventional Cardiologist, Asian Heart Institute, Mumbai, Maharashtra, India.; Interventional Cardiology, Department of Cardiology, Apollo Hospital, Bhubaneshwar, Odisha, India.; Consultant and Head, Department of Nephrology, Moolchand Centre for Renal Care and Dialysis, Moolchand Hospital, India.; Senior Director and Head, Department of Nephrology and Renal Transplantation, BLK-Max Super Speciality Hospital, Delhi, India.; Senior Director, Interventional Cardiology, Medanta-The Medicity, Gurugram, Haryana, India.; Director, Department of Interventional Cardiology, Head of Advanced Heart Failure Program, Fortis Escort Heart Institute, Delhi, India.; Senior Consultant & Director of Clinical Research Cardiology, Chennai, Tamil Nadu, India.; Senior Cardiologist, Billroth Hospitals, Chennai, Tamil Nadu, India.; Consultant Physician and Diabetologist, Shilpa Medical Research Centre, Mumbai, Maharashtra, India.; Senior Consultant, Department of Cardiology, Medanta Heart Institute, Patna, Bihar, India.; Consulting Physician, Department of Internal Medicine, Kishori Ram Hospital and Diabetes Care Centre, Bathinda, Punjab, India.; Director and Senior Consultant Cardiologist, Med N Heart Clinic, Cuttack, Odisha, India.; Professor and Head, Department of Cardiology, SCB Medical College, Cuttack, Odisha, India.; Director, Department of Non-Invasive Cardiology, Fortis Escorts Heart Institute, New Delhi, India.; Senior Vice President, Medical Services, Alembic Pharmaceuticals Ltd., Mumbai, Maharashtra, India, Corresponding Author.; Director, Department of Cardiac Pacing and Electrophysiology, Fortis Escorts Heart Institute, Delhi, India.; Consultant Interventional Cardiologist, Jay Prabha Medanta Super Specialty Hospital, Patna, Bihar, India.; Consultant Cardiologist, Sir Ganga Ram Hospital, Delhi, India.; Senior Consultant Cardiologist, Apollo Hospital, Delhi, India.; Professor, Department of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India.; Head, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.; Consultant Interventional Cardiologist, Ashwin Clinic, Chennai, Tamil Nadu, India.; Chairman and Head, Department of Cardiology and Structural Heart Disease, BLK-Max Super Speciality Hospital, New Delhi, India.; Senior Professor, Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, Delhi, India.; Senior Consultant, Interventional Cardiologist, Fortis Escorts Heart Institute, New Delhi, India.; Director, Clinical & Preventive Cardiology, Medanta-The Medicity, Gurugram, Haryana, India.; Associate Vice President, Medical Services, Alembic Pharmaceuticals Ltd., Mumbai, Maharashtra, India.; Assistant General Manager, Medical Services, Alembic Pharmaceuticals Ltd., Mumbai, Maharashtra, India.; Director of Cardiology and Interventional Cardiologist, Max Hospital, Delhi, India.; Professor and Former Head, Department of Cardiology, St. John's Medical College, Bengaluru, Karnataka, India.; Professor and Former Head, Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.; Director, Interventional Cardiology, Max Super Speciality Hospital, Delhi, India.; Assistant Professor of Medicine and Cardiology, Icahn School of Medicine at Mount Sinai; Director, Heart Failure Program, Mount Sinai Morningside Hospital, New York, United States of America.; CVTS, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.; Consultant, Department of Cardiology, Dayanand Medical College and Hospital (DMC&H), Ludhiana, Punjab, India.; Senior Consultant in Cardiology, Sri Rama Chandra University, Chennai, Tamil Nadu, India.; Senior Interventional Cardiologist and Head of Cardiology, Department of Interventional Cardiology, Jubilee Memorial Hospital, Thiruvananthapuram, Kerala, India.; Head of Department, Department of General Medicine, Positron Hospital; Formerly Senior Professor, Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.; Director, Department of Cardiology, Sir Ganga Ram Hospital, Delhi, India.; Director and Head, Department of Non-Invasive Cardiology, Delhi, India.; Senior Director, Department of Nephrology and Renal Transplant, Max Super Speciality Hospital, Delhi, India.; Senior Consultant Diabetologist and Head, Centre for Diabetes and Metabolic Diseases, Heart and Lung Institute, Delhi, India.; Senior Interventional Cardiologist, Director Cath Lab, Apollo Hospital, Indore, Madhya Pradesh, India.; Director, Department of Anaesthesia and Critical Care, Moolchand Hospital, Delhi, India.; Consultant and Critical Care Specialist, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India.; Consultant and Critical Care Specialist, Moolchand Hospital, Delhi, India.; Consultant Cardiologist, HCG Suchirayu Hospital, Hubballi, Karnataka, India.; Consultant Cardiologist, Indraprastha Apollo Hospital, Delhi, India.; Senior Consultant Cardiologist, Department of Cardiology, Kailash Deepak Hospital, New Delhi, India.; Senior Consultant Diabetologist and Director of North Delhi Diabetes and Cardiac Centre, Delhi, India.; Consultant Diabetologist and Head, Dr Mohans Diabetes Specialities Centre, Delhi, India.; Senior Consultant Nephrology, Sri Balaji Action Medical Institute, Delhi, India.; Head of Department and Chief Interventional Cardiologist, Yashoda Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India.; Director and HOD, Department of Cardiology and HF, Fortis Shalimar Bagh Hospital, Delhi, India.; Senior Director and Unit Head, Max Super Speciality Hospital, Saket, New Delhi, India.; Director and Unit Head, Department of Cardiology, Dharamshila Narayana Superspeciality Hospital, New Delhi, India.; Consultant Interventional Cardiologist, Medanta Hospital, Gurugram, Haryana, India.; Interventional Cardiologist, Fortis Hospital, Delhi, India.; Consultant Cardiologist, Medanta Moolchand Heart Centre, Delhi, India.
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