Abstract
Purpose PIONEER-HF established the safety of the angiotensin receptor-neprilysin inhibitor (ARNI), sacubitril-valsartan (S/V), in patients hospitalized with acute decompensated heart failure after achieving hemodynamic stability. We have previously shown that transitioning patients in ADHF with low cardiac output directly from intravenous (IV) vasoactive (i.e. vasodilators or inotropes) drugs to ARNI can be done safely with tolerance to one-month follow-up. Here we further characterize the acute hemodynamic impact of ARNI therapy after patients have been optimized on IV vasoactive therapy. Methods A single-center, retrospective analysis of all patients with HFrEF (EF Conclusions ICU patients can be successfully bridged from vasoactive IV therapy to oral ARNI with sustained improvement in cardiac index garnered from vasoactive agents. We also observed improvement in PAPI along with maintenance of LV/RV unloading with ARNI. These encouraging findings merit prospective validation of ARNI compared to more commonly used oral vasodilators in ICU care.
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