Initiating sacubitril-valsartan in adults with heart failure with preserved ejection fraction*

SGLT2: sodium-glucose co-transporter 2; NYHA: New York Heart Association; ACE: angiotensin converting enzyme; ARB: angiotensin II receptor blocker; LVEF: left ventricular ejection fraction; GFR: glomerular filtration rate.
* Of note, adverse effects (eg, hypotension) and high cost compared with other antihypertensive agents may outweigh potential small benefits of sacubitril-valsartan. Where cost or availabilty preclude use, continue standard of care treatment of cormorbid conditions.
¶ Refer to UpToDate content on treatment and prognosis of heart failure with preserved ejection fraction for dosing of SGLT2 inhibtors and spironolactone. Refer to UpToDate algorithm for initiation and optimization of spironolactone dose.
Δ Sacubitril-valsartan cannot be used concomitantly with either an ACE inhibitor or ARB.