Purpose: Angiotensin receptor-neprilysin inhibitor (ARNI) therapy has been reported to be initiated in patients on vasoactive medications during acute decompensated heart failure. However, there is no report regarding the safety of initiating ARNI therapy in patients receiving inotrope infusion in an outpatient setting. Summary: We described a case of initiating post-discharge ARNI therapy in a 41-year-old man with inotrope-dependent heart failure in an outpatient setting. Two weeks after the initiation of low dose sacubitril/valsartan, milrinone was successfully discontinued without any adverse effects. Conclusion: With close monitoring, ARNI therapy could be safely initiated in hemodynamically stable patients receiving intravenous inotrope, and further investigation is needed to confirm our findings.
VelazquezEJMorrowDADeVoreAD, et al. Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med. 2019;380(6):539-548.
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MartynTFaulkenbergKDYaranovDM, et al. Initiation of angiotensin receptor-neprilysin inhibitor in heart failure with low cardiac output. J Am Coll Cardiol. 2019;74(18):2326-2327.
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JanuzziJLJrPrescottMFButlerJ, et al. Association of change in N-terminal pro-B-type natriuretic peptide following initiation of sacubitril-valsartan treatment with cardiac structure and function in patients with heart failure with reduced ejection fraction. JAMA. 2019;322(11):1-11.
