GoodRx helps find the best price for you. Impaired Renal Function: Decreases in renal function may be This potentially life threatening condition means the heart cannot pump enough blood and oxygen to organs throughout the body. Blocking neprilysin raises levels of several substances in the body that have beneficial effects on the heart, blood vessels, and kidneys, which can help with blood flow in people with heart failure. The primary end point was the correlation between change in NT-proBNP and cardiac remodeling parameters at 12 months. Theyre just chemical markers that your doctor uses to check your heart health and your hearts response to Entresto. Sacubitril, one of the active drugs in Entresto, blocks your body from breaking down BNP. This causes BNP levels to rise when you take Entresto. doi: Liu LW, et al. antagonists. They may be used in patients who cannot tolerate or use an ACE inhibitor, ARNI, or ARB. In our quest to find new medicines, we consistently rank among the worlds top companies investing in research and development. You also might need a different dose if you have kidney or liver problems. or salt substitutes containing potassium, may lead to increases in serum potassium. Each hospitalization event is associated with worsening long-term prognosis7. Explore our history which goes back more than 250 years. Ask your doctor or other healthcare provider for his or her recommendations, and accept the encouragement and support of family members or friends who can help you reach your goals. Correct volume or salt depletion prior to administration of ENTRESTO or start at a lower dose. Your Kidneys and Heart Failure: How Theyre Related, Stress-Induced Cardiomyopathy: Symptoms and Treatment. Entresto is usually taken twice a day. About 110,000 people of more than 140 nationalities work at Novartis around the world. Its important to note that many factors can influence the expected lifespan of someone with heart failure. Updates and resources for investors including financial information, disclosures, events, share price, ESG and reporting. Association of change in n-terminal prob-type natriuretic peptide following initiation of sacubitril-valsartan treatment with cardiac structure and function in patients with heart failure with reduced ejection fraction. Patients with HFrEF who were candidates for Well, there are many types of medications. Benefits are most clearly evident in patients Novartis Pharmaceuticals Corporation. Nitrates / hydralazine may be used alternatively in people who cannot tolerate an angiotensin system blocker. Entresto is a medication that may help those with heart failure. If youre just getting started, walking is a good and safe way to begin. anticipated in susceptible individuals treated with ENTRESTO. East Hanover, NJ: Novartis Pharmaceuticals Corp; February 2021. In 2021, the FDA expanded its approval of Entresto to include people with heart failure with preserved ejection fraction (HFpEF). This is because of the higher risk of high potassium, kidney problems, low blood pressure, and angioedema. After discontinuing their existing ACEi or ARB therapy, patients entered sequential single-blind Medications are one way doctors try to increase the hearts ejection fraction. symptomatic hypotension. Entresto is now approved for use in people with heart failure with reduced ejection fraction (HFrEF) and in certain people with heart failure with preserved ejection fraction (HFpEF). ENTRESTO 97/103 mg (n=4209) twice daily or enalapril 10 mg (n=4233) twice daily. Why is my EF low and how does it affect my health? Other common HF medicines, called angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs), only block the harmful effects of the overactive RAAS. Frequently caused by heart failure, Hidradenitis suppurativa (HS) is a disease that causes swollen, painful bumps to form on the skin. In the United States, Ejection fraction is how well your heart chambers (the ventricles) can pump blood to your body to deliver oxygen and nutrients. Lithium: Increases in serum lithium concentrations and lithium 2016;18(9):1193-1202. doi:10.1002/ejhf.548. You may have specific instructions from your healthcare provider about how to take the medication when you start. If youre eligible, a manufacturer savings card can help you access Entresto for as little as $10 per month. Colucci W et al. About NovartisNovartis is reimagining medicine to improve and extend peoples lives. For the primary end point, composite of CV death or first heart failure hospitalization, Learn about our innovation engine, the Novartis Institutes for BioMedical Research (NIBR) and explore our research areas, technology platforms and pipeline. They can help widen blood vessels and reduce blood pressure. Entresto wins first FDA nod in hard-to-treat type of heart failure. failure in adult patients with chronic heart failure. LVEF is a variable measure, so use clinical judgment in deciding whom to treat. serum potassium periodically and treat appropriately, especially in patients with risk factors for They can help wid use of aliskiren in patients with diabetes. The use of -blockers in heart failure with reduced ejection fraction. WebStudies have shown that Entresto is effective at improving ejection fraction. Hypotension: ENTRESTO lowers blood pressure and may cause another ACEi (eg, lisinopril 10 mg; ramipril 5 mg)2, Low-dose ARB: The possible side effects of Entresto are similar to effects you might see with an ACE inhibitor or ARB. Following completion, echocardiograms were transmitted in a secure fashion to a core laboratory, where they Dosage reduction or interruption of ENTRESTO may be required. Examples include canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance) and ertugliflozin (Steglatro). Entresto [package insert]. Examples of Entrestos commonly reported side effects include: cough. But it looks unlikely to be able to repeat the trick in post-myocardial infarction patients, full results from the Paradise MI trial suggest. Once it is diagnosed, using a continuous positive airway pressure mask at night can restore a normal sleeping pattern and increase daytime energy. Studies have shown that Entresto is effective at improving ejection fraction. Efectele secundare par s apar ntr-un grad similar la copii i aduli, dar studiile asupra sigurana Entresto la copii sunt n curs de desfurare. Track and respond to weight fluctuations. This article details how Entrestro works, the potential side effects, and how effective it may be. Should you drink a lot of water when taking Lasix? Available for Android and iOS devices. Worldwide, it is estimated that more than 30,000 patients have participated in the Entresto clinical trials program, and it is estimated that more than 2.8 million patients are on treatment with Entresto today. Weiner RB, Baggish AL, Chen-Tournoux A, et al. As a leading global medicines company, we use innovative science and digital technologies to create transformative treatments in areas of great medical need. FortiHFy includes trials across the spectrum of heart failure, such as PARADIGM-HF, PIONEER-HF, TRANSITION, PROVE-HF, PARAGON-HF and PARAMOUNT. heart failure), treatment with ACE inhibitors and angiotensin receptor antagonists has been associated This label expansion is based on efficacy and safety evidence observed in PARAGON-HF, the largest and only Phase III active-controlled study to date in patients with guideline-defined HFpEF2,5,6. The New England Journal of Medicine. Angioedema: ENTRESTO may cause angioedema. Novartis. Alcohol or marijuana ( cannabis) can make you more dizzy. dizziness. The American Heart Association is a qualified 501(c)(3) tax-exempt organization. Entresto is the sole member of a class of drugs called angiotensin receptor neprilysin inhibitors. aliskiren in patients with renal impairment (eGFR <60 mL/min/1.73 m2). Initially, this may include 3 medicines from 3 different drug classes: a diuretic, an agent that blocks the renin-angiotensin system (ACE inhibitor, ARB or ARNI), and a beta blocker. All rights reserved. LVEF=left ventricular ejection fraction; NT-proBNP=N-terminal prohormone of brain natriuretic peptide; Information for patients and their caregivers including clinical trial recruiting, managed access programs, funding opportunities for patient organizations and side effects reporting. another ACEi (eg, lisinopril >10 mg; ramipril >5 mg)2, High-dose ARB: Cardiac remodelingconcepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. 3. Patients with heart failure usually have an ejection fraction of 40% or less. When switching from ACEi, be sure to An ICD is usually advised for people with an EF of 35 or lower. ENTRESTO [prescribing information]. It is used for the treatment of patients with heart failure and reduced ejection fraction (HFrEF). The greatest benefit was shown in patients with LVEF below normal6. Approved indications may vary depending upon the individual country. As an added bonus, you may also see an improvement or even a recovery of your hearts ejection fraction. In HFrEF, your EF is much lower than it should be (an EF below 40%). 2023 American Heart Association, Inc. All rights reserved. It is frequently given with other heart failure medications in place of an ACE inhibitor or ARB. Angioedema: ENTRESTO may cause angioedema. Medications are one way doctors try to increase the hearts ejection fraction. Most HF exercise programs focus on improving your ability to sustain aerobic activity. If serious side effects occur while using Entresto, contact your doctor and seek immediate medical help. LAVI=left atrial volume index; LVEDVI=left ventricular end-diastolic volume index; 2019;7(2):158-168. doi:10.1016/j.jchf.2018.10.014 LVEF is a variable measure and the normal range can vary.1. Your doctor may suggest a cardiac rehabilitation program for you to increase the ability to exercise. median LVEF was 57%. Not everyone. renal artery stenosis. What is the normal ejection fraction of the heart? Sleep apnea is common in heart failure. The side effects of Entresto include: Low blood pressure (causing dizziness or lightheadedness), Angioedema - a serious reaction that can cause throat swelling and trouble breathing. Different pharmacies offer different prices for the same medication. heart failure), treatment with ACE inhibitors and angiotensin receptor antagonists has been associated allow for a 36-hour washout period prior to initiating ENTRESTO.1, No starting dose adjustment is needed for mild or moderate renal impairment, No starting dose adjustment is needed for mild hepatic impairment. Resources for physicians and other healthcare professionals including clinical trial recruiting, grant funding, congresses and country-level information. What Is Flash Pulmonary Edema, and How Do You Treat It? Before you decide on your next steps, first discuss the following questions with your healthcare provider: Find out if your HF is clearly linked to an underlying cause. Entresto is a newer combination of two medicines: the neprilysin inhibitor sacubitril and the angiotensin receptor blocker (ARB) valsartan. with left ventricular ejection fraction (LVEF) below normal. Entresto is usually given together with other heart failure medications, in place of an ACE inhibitor or ARB. Ventricular remodeling: fundamental to the progression (and regression) of heart failure. Avoid use with Benefits are most clearly evident in patients with left ventricular ejection fraction (LVEF) below normal1. ENTRESTO [prescribing information]. Entresto (sacubitril/valsartan) is used to treat people with long-lasting (chronic) heart failure. The median follow-up duration was 27 months, and patients were treated for up to 4.3 years.3 (2017). Tracking your weight can give you important clues about how well your heart is managing its load. Also, increasing movement via daily walks can help. Entresto may therefore increase the systemic exposure of OATP1B1 and OATP1B3 substrates such as statins. Treatment goals for heart failure include: Your doctor will determine which medicines are best for you based on your symptoms and heart failure classification, physical and history, previous treatments, imaging tests and lab work. This link is provided for convenience only and is not an endorsement of either the linked-to entity or any product or service. contraindicated in patients with a history of angioedema related to previous angiotensin-converting Entresto should not be taken with an ACE inhibitor or ARB. At first, this may involve 3 different medicines from 3 different drug classes: a diuretic, an agent that blocks the renin-angiotensin system (ACE inhibitor, ARB or ARNI), and a beta blocker. Explore the Novartis in Society Integrated Report. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised You may notice patterns that help you respond appropriately to situations before they get worse. Always follow the instructions from your healthcare provider about taking Entresto, as there can be special directions for how to start or stop the medication. A patient assistance program is also available. LVEF is a variable measure, so use clinical judgment in deciding whom to treat. The average American consumes about 3,400 milligrams of sodium per day, which can result in the body holding excess fluids and create an added strain on the heart. The prevalence of diabetes is around 35-40% in patients with HF. You will have regular blood work done to help monitor for these effects. No new adverse reactions were identified in a trial of the remaining indicated population. The investment you are making to help yourself recover is your best pathway for taking control of your health. In PARAGON-HF, defined as LVEF 45% with structural heart disease (LAE or LVH); median LVEF was 57%. Masarone D, et al. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise. 4.2 Posology and method of administration. ENTRESTO has been associated with a higher rate of angioedema in Black patients and in patients with LS geometric mean concentration changes from baseline NT-proBNP to follow-up. doi:10.1001/jama.2019.12821. Entresto is one of the drugs doctors may prescribe for heart failure. Pathophysiologic targets in the early phase of acute heart failure syndromes. By providing your email address, you agree to receive emails containing coupons, refill reminders and promotional messages from GoodRx. Find open positions, learn more about our strategy and culture, and apply today. Langenickel T, Dole W. Angiotensin receptor-neprilysin inhibition with LCZ696: a novel approach for the treatment of heart failure. Learn about how Novartis is organized and our strategy, vision and mission. Accessed Dec. 27, 2021 at https://www.uptodate.com/contents/secondary-pharmacologic-therapy-in-heart-failure-with-reduced-ejection-fraction-hfref-in-adults, Corlanor prescribing information. Intermountain Healthcare and Story Health Partner to Optimize Rural Heart Failure Care. In some cases, drug classes may need to be combined to help lower fluid excess. To this point, the revised ECDP recommends combination ACE inhibitor/ARB therapy only for patients who are intolerant of Entresto, for whom the RAAS inhibitor is contraindicated, or for those without access to it. (2019. Its really just common sense. Entresto works by stopping an enzyme called neprilysin from doing its job. But neprilysin plays a critical role in keeping clusters of amyloid beta plaques from forming in your brain. And clearing those plaques is crucial in preventing Alzheimers disease. Use of website is governed by the Entresto is a newer combination of two medicines: the neprilysin inhibitor sacubitril and the angiotensin receptor blocker (ARB) valsartan. Entresto has been approved in the EU since 2015 in adult patients for treatment of symptomatic chronic heart failure with reduced ejection fraction (HFrEF)4. No, Entresto isnt known to cause weight gain. About our longstanding commitment to heart failureOur goal is to reimagine medicine for heart failure patients. A brief warm up and cool down can help your body transition smoothly in and out of your exercise zone and reduce symptoms of dizziness and/or lightheadedness. So, you may be asked to avoid taking NSAIDs to avoid these effects. The ACC report, considered interim guidance, also incorporates the considerable impact of the coronavirus disease 2019 (COVID-19) pandemic on outpatient management of chronic disease states such as HFrEF, along with coverage of these 10 fundamental issues: Additional key points include that ARNIs now top the list of recommended angiotensin antagonists, as well as recommendations to conduct biweekly assessments to reach a solid therapy plan by a maximum of 6 months after HF diagnosis; inform patients of financially feasible opportunities such as virtual care when the cost of medications poses a barrier to use, which can lead to adverse patient outcomes; and facilitate team-based care through the use of smart technology. If your blood pressure goes too low, you can feel dizzy or lightheaded, and you should let your healthcare provider know. For example, other conditions such as kidney disease and the degree of heart failure before treatment can all impact lifespan. Before starting any medication, discuss the potential side effects with your doctor. NT-proBNP goal achievement is associated with significant reverse remodeling and improved clinical outcomes in HFrEF. Congestive heart failure resolved in each case. Thus, the medication class name for Entresto is angiotensin receptor neprilysin inhibitor or ARNI for short. It can help with heart failure symptoms like shortness of breath and fluid retention. It can also slow the advancement of heart failure. Sacubitril is the newer half of Entresto. 5. The starting dose may be lower if you havent taken an ACE inhibitor or ARB in the past. Less oxygen can lead to symptoms like trouble exercising and shortness of breath. Unauthorized use prohibited. A severe reaction to any medication is a medical emergency. Welcome to Novartis where we are reimagining medicine to improve and extend peoples lives. The more blood that is pumped out, the healthier the heart is. Had cardioversion to get out of a-fib. Corlanor works by affecting the electrical activity of your heart in order to slow down the heart rate. Over time, as the medications are working, your heart may be able to recover, strengthen and perform better. The serious side effect of angioedema is very rare and usually happens after the first dose of the medication. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Closely monitor serum Monitor They also help to protect your heart from hormones that can be released in people with heart failure. 2. Although the FDA has approved this medication, side effects are possible. Ejection fraction heart failure measurement. Benefits are most clearly evident Angiotensin-neprilysin in heart failure with preserved ejection fraction. Smoking cigarettes is especially hazardous to people with heart failure. The decision to start Entresto will depend on your heart function and your heart failure symptoms. Initial pharmacologic therapy of heart failure with reduced ejection fraction in adults. Thiazide diuretics may include agents like chlorothiazide or chlorthalidone, but are not as strong as loop diuretics. It can be a side effect of being overweight or a symptom of heart failure and other. ENTRESTO [prescribing information]. The valsartan portion of Entresto works by blocking a hormone that causes blood vessels to narrow. This achievement would not have been possible without tremendous dedication from investigators, patients in our clinical trials and the advocacy community, to whom we are extremely grateful.. Verquvo is a stimulator of soluble guanylate cyclase, an important enzyme in the nitric oxide signaling pathway. WebENTRESTO is indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure. Sign up for our Heart Health Newsletter to receive up-to-date information on the latest medications, nutrition tips, and savings that are most relevant to you. One month later (35 days) had another echocardiogram showed 45-50% ejection fraction. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. Does Entresto improve your hearts ejection fraction? creatinine, and down-titrate or interrupt ENTRESTO in patients who develop a clinically significant Practical information and resources for suppliers around the world. Entresto can cause higher lithium levels if you are taking lithium. It ranges from 1 (exactly correlated) to -1 Unless your patient is on a high ACEi/ARB dose, start ENTRESTO at 24/26 mg twice daily and double The PROVE-HF trial showed a median increase in left ventricular ejection fraction from 28.2% to 37.8% at 12 months. It's often caused, Taking diuretics is part of standard heart failure treatment, but these medications may carry some potentially serious side effects and can cause, Because stress-induced cardiomyopathy and a heart attack have similar symptoms, its critical you treat sudden and intense chest pain and related, Flash pulmonary edema comes on quickly and can leave an individual gasping for air or coughing up bloody phlegm. Click here for full Prescribing Information. In seeking to become the first FDA-approved medication to treat patients who have HF with preserved ejection fraction (HFpEF), Entresto went up for a December 2020 vote before the FDAs Cardiovascular and Renal Drugs Advisory Committee. LVEF is a variable measure and the normal range can vary.1. If angioedema occurs, discontinue ENTRESTO immediately, provide appropriate therapy, and monitor for Understanding the Unmet Need for Therapies to Treat Rare Bile Duct Cancer. Monitor hyperkalemia such as severe renal impairment, diabetes, hypoaldosteronism, or a high potassium diet. Sacubitril/valsartan across the spectrum of ejection fraction in heart failure. Learn about our commitments to making a positive impact on the world by providing access to innovative medicines, protecting the environment, and upholding high ethical standards. Treatment optimization for heart failure with reduced ejection fraction is the focus of the American College of Cardiologys 2021 update to its 2017 Expert Consensus Decision Pathway on managing patients with the condition. People with improved or recovered ejection fractions, as a whole, tend to have fewer hospitalizations and better overall outcomes. Cohn JN, Ferrari R, Sharpe N; on behalf of an International Forum on Cardiac Remodeling. ENTRESTO is indicated to reduce the risk of cardiovascular death and hospitalization for heart Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Benefits are most clearly evident Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF registry. For those less than 88 pounds (40 kg) the starting dose is 1.6 mg of combined sacubitril and valsartan per kg of body weight. discontinue ENTRESTO. About EntrestoIn Europe, Entresto is indicated in adult patients for the treatment of symptomatic chronic HF with reduced ejection fraction10. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Pets and Your Health / Healthy Bond for Life, La Iniciativa Nacional de Control de la Hipertensin, Download a printable version of this information (PDF), AHA recommendations of no more than 1,500 milligrams of sodium per day, HF and Your Ejection Fraction Explained (PDF). Colucci W et al. were interpreted following completion of all study protocols in a temporally and clinically blinded fashion. Drugs.com. Do not administer Common Adverse Events: In a clinical trial of patients with heart failure with reduced ejection fraction, Entresto is the first and only therapy approved in the US to treat patients diagnosed with guideline-defined heart failure to include both those with heart failure with This cross-sectional observational study found several factors associated with whether a patient had sufficient lung cancer risk factor documentation in the electronic health record. No significant differences have been noted in giving Entresto to older people. Most of the time, these bumps appear in areas like, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. 36 hours of switching from or to an ACE inhibitor. Ejection fraction is the measurement term for how much blood leaves the heart ventricle every time it pumps. 6. Discover how ENTRESTO patients reported feeling vs enalapril. enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy. In an exploratory analysis, ENTRESTO lowered NT-proBNP by 32% vs 7% with enalapril, compared to baseline (screening), at 4 weeks One focus of the 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction is optimizing HFrEF treatment through expanded use of Entresto (sacubitril/valsartan; Novartis). the angiotensin II receptor blocker valsartan. (PROVE-HF). This means you will need to stop taking all ACE inhibitors or ARBs for 36 hours prior to starting Entresto. Although individual results may vary, the efforts you put into improving your hearts ejection fraction can have additional positive results. Beta blocker examples used in heart failure include carvedilol (Coreg), metoprolol (Lopressor, Toprol XL, Kapspargo Sprinkle), and bisoprolol. With a twice-a-day dosage, steady levels can be achieved in 3 days. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Until now, treatment for these patients was largely empiric, said Scott Solomon, MD, Professor of Medicine at Harvard Medical School and Brigham and Women's Hospital, and PARAGON-HF Executive Committee Co-Chair. If your heart failure is stable, and you have your doctors okay, do what moves you. These effects are usually reversible. Entresto is FDA-approved for chronic (long-term) heart failure in adults. You can learn more about how we ensure our content is accurate and current by reading our. Observational, single-group, open-label design, A broad range of factors may affect NT-proBNP concentrations besides cardiac remodeling, Multiple comparisons may have increased risk of type 1 error, Not all echocardiographic measurements were available at each time point. If you think youre having a reaction to Entresto, let your healthcare provider know immediately. Many people with a low ejection fraction (or EF) have successfully improved it. receptor blockers, or neprilysin inhibitors, Any angioedema history (drug-related or otherwise), Concomitant use of ACEi therapy, nesiritide, aliskiren, or drugs that may affect absorption WebResults: During the follow-up period, the average ejection fraction improved in 11 patients from 21.9 +/- 4.23% to 56.64 +/- 10.22%. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. ARBs: Avoid use of ENTRESTO with an ARB, because ENTRESTO contains Mineralocorticoid receptor antagonists (MRA) which are potassium-sparing diuretics include spironolactone (Aldactone. LVEF is a variable measure and the normal range can vary.7. J Am Coll Cardiol. They work by widening blood vessels. This approval is a significant advancement, providing a treatment to many patients who were not eligible for treatment before because their ejection fraction was above the region we normally considered reduced. JACC Cardiovasc Imaging. failure in adult patients with chronic heart failure. Begin and end with a warm-up and cool down. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. Concomitant use of Entresto with an angiotensin-converting enzyme (ACE) inhibitor or ARB is contraindicated, however, due to respective risks of angioedema and hypotension, acute kidney injury, and hyperkalemia. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure: 1993-2008. This occurs when the hearts left ventricle becomes enlarged and fails to properly push blood into the circulatory system. Published online January 4, 2021. doi:10.1016/j.jacc.2020.11.022, Younger Women vs Men Have Worse Outcomes Following AMI. J Am Coll Cardiol. a prior history of angioedema. Novartis Pharmaceuticals Corporation. Entresto is given together with other heart failure medications. Circulation. Factors to consider if you can take Entresto for the heart. Sacubitril also helps the body get rid of extra fluid, and helps with fluid retention which is a common problem in people with long-term heart failure. or salt substitutes containing potassium, may lead to increases in serum potassium. and Accessed Dec. 27, 2021 at https://www.uptodate.com/contents/initial-pharmacologic-therapy-of-heart-failure-with-reduced-ejection-fraction-in-adults. This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment.
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