Recommendations
7.3.2.10. Renin-Angiotensin System Inhibition With Angiotensin-
Converting Enzyme Inhibitor or Angiotensin Receptor
Blocker or ARNI: Recommendations
COR
LOE Recommendations
I e clinical strategy of inhibition of the renin-angiotensin system with:
A ACE inhibitors, OR
A ARBs, OR
B-R ARNI*
In conjunction with evidence-based beta blockers, and aldosterone
antagonists in selected patients, is recommended for patients with chronic
HFrEF to reduce morbidity and mortality.
I A e use of ACE inhibitors is beneficial for patients with prior or
current symptoms of chronic HFrEF to reduce morbidity and
mortality.
I A e use of ARBs to reduce morbidity and mortality is recommended
in patients with prior or current symptoms of chronic HFrEF who
are intolerant to ACE inhibitors because of cough or angioedema.
I B-R In patients with chronic symptomatic HFrEF NYHA class II or III
who tolerate an ACE inhibitor or ARB, replacement by an ARNI is
recommended to further reduce morbidity and mortality.
III:
Harm
B-R ARNI should not be administered concomitantly with ACE
inhibitors or within 36 hours of the last dose of an ACE inhibitor.
III:
Harm
C-EO ARNI should not be administered to patients with a history of
angioedema.
7.3.2.11. Ivabradine: Recommendation
COR
LOE Recommendation
IIa B-R Ivabradine can be beneficial to reduce HF hospitalization for
patients with symptomatic (NYHA class II-III) stable chronic
HFrEF (LVEF ≤35%) who are receiving GDEM, including a beta
blocker at maximum tolerated dose, and who are in sinus rhythm
with a heart rate of 70 bpm or greater at rest.
* sacubitril/valsartan is the only FDA approved ARNI.
