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.
Sacubitril/valsartan (Entresto), the first angiotensin receptor-neprilysin inhibitor (ARNI), is a recently licensed medication that has been shown to improve outcomes for patients with symptomatic chronic HF with reduced ejection fraction (HF-REF) compared with current gold-standard treatment with an ACE inhibitor. This article describes the pharmacist’s role in supporting patients receiving sacubitril/valsartan.
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.
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 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.
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.
There’s been a lot of important new evidence about the practical benefits of SGLT2 inhibitors this year. Professor Cliff Bailey and colleagues tell us what we need to know about SGTL2 inhibitors and their mode of action plus their metabolic, cardiovascular and renal effects.
Sitagliptin (trade name Januvia) is the first in a new class of drugs for diabetes – the dipeptidyl peptidase-4 (DPP-4) inhibitors. This new, oral hypoglycaemic agent has recently been approved for the treatment of type 2 diabetes. It is available on prescription and can be prescribed in primary care. Principal advantages include lack of weight gain and hypoglycaemia, which should make sitagliptin very popular with patients. This article looks at what a DPP-4 inhibitor is and how it works to lower blood glucose, as well as where this class of drug fits into current practice.
Stable angina is very common. Just under two million people in the UK – over one million men and 840,000 women – have, or have had, angina. In this article we review how new-onset stable angina is assessed, including an update on new investigations, and the latest treatment options including drugs and interventions, based on the most up-to-date guidelines and current practice.