The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement

Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.

Urinary Tract Infections in Women.

Urinary tract infections (UTIs) are one of the most common bacterial infections seen in primary care, second only to infections of the respiratory tract. Women are particularly at risk of developing UTIs because of their short urethra, and certain behavioral factors which include delay in micturition, sexual activity and the use of diaphragms and spermicides. Uncomplicated UTIs are usually treated empirically with antibiotics. However, not everyone diagnosed with a UTI and treated with an antibiotic will necessarily have a bacterial infection. At least one-half of women who suspect that they have UTI actually do. Studies have shown that one in 7 patients given an antibiotic for UTI symptoms will return within 28 days for a further prescription of antibiotic. Also, many UTIs are self-limiting, improving without treatment even when culture is positive. Symptomatic treatment of uncomplicated UTI may be an option which merits further research. Phenazopyridine is a time-tested urinary tract antiseptic and analgesic that provide symptomatic relief of the pain, burning, frequency and urgency associated with UTI.