Commissioning is not so different from seeing patients. As a GP you listen, examine, draw up a diagnosis and plan treatment. In commissioning, the community served by the clinical commissioning group (CCG) is the ‘patient’. When considering the introduction of a new treatment for heart failure (HF) such as sacubitril/valsartan (Entresto), we must consider not only its acquisition costs but also its potential benefits in improving patients' symptoms and reducing expensive hospital admissions.
Many patients with heart failure rely on practice nurses to monitor their care. A multidisciplinary team (MDT) integrated community approach has been endorsed by NICE guidelines when delivering HF care. This article provides practice nurses with the information they need to understand the condition, current treatment guidelines, and the new treatment – sacubitril/valsartan, the first-in-class angiotensin receptor-neprilysin inhibitor.
A number of drug classes are used in the treatment of patients with heart failure. This illustrated Back to Basics poster describes the various drugs and their mechanisms of action to give health care professionals and their patients a greater understanding of heart failure management and where sacubitril/valsartan fits into the picture.
This article describes the use of sacubitril/valsartan – the first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) in primary care and how the new drug fits in the heart failure treatment pathway. Current guidelines and case studies are also explored to provide further understanding of this latest HF treatment to enter clinical use.
The large randomised controlled trial PARADIGM-HF showed that treatment with sacubitril/valsartan (Entresto) compared with enalapril reduced the risk of hospitalisation, cardiovascular and all-cause mortality and improved symptoms in patients with heart failure with reduced ejection fraction. This article describes the key results and how they can be applied in primary care.
This article gives an overview of sacubitril/valsartan (Entresto), a first-in-class angiotensin receptor-neprilysin inhibitor comprising valsartan, an angiotensin II receptor blocker and the neprilysin inhibitor sacubitril. The drug has been approved for the treatment of symptomatic (NYHA class (II-IV) chronic heart failure and reduced ejection fraction (HF-REF) in adults.
The mechanisms underlying HF are complex and involve the interaction of many hormonal and molecular signalling pathways. These pathways form the basis of many pharmacological treatments, old and new. This article will examine the factors associated with the development of HF, the pathophysiology behind it and the neurohormonal pathways involved in established HF.
This useful Back to Basics poster describes the damaging changes that take place in three key body systems when HF with reduced ejection fraction is left untreated. The sympathetic nervous system, the renin-angiotensin-aldosterone system and the natriuretic peptide system all undergo significant pathophysiological changes as HF progresses.
The UK faces an epidemic of heart failure (HF). NICE guidelines emphasise the importance of multidisciplinary assessment and care by HF specialists, evidence-based prescribing, and careful discharge planning after hospitalisation. This article highlights areas where improvements can be made in the management of HF including taking lessons from the latest National Heart Failure Audit.
HF has a major impact on patients, their families, the NHS and social care services. It still has a poor prognosis, worse than many of the common cancers that also affect older people. It causes significant morbidity and imposes a major cost burden on the health service. This editorial provides an introduction to a special supplement on a first-in-class oral treatment for heart failure.