ABSTRACT
Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.
ABSTRACT
The changing scenario between society’s lookout toward the medical profession has taken a bad turn. The stress of education, practice starting, increasing to a peak of one’s performance in the early years and later on to maintain it after the age of 50 is a great challenge. Recent tragic events have brought up the role of social elements, media, press, politicians, police, and prosecutors under the lens. We as professionals and organizations must find out the weakest link which enforces someone to indulge in self-harm. We also should try to strengthen the chain of healthcare delivery system with the motto of “A healthy physician only can impart quality healthcare. His image, interests, and intentions must be protected by our own profession, society, policymakers— government agencies.” Doctor–patient relationship has always been the foundation of healthcare system. Since the times of Hippocrates, relationship of doctor–patient has been extensively debated, receiving attention pertaining to its sociological, literary, and philosophical aspects. At present, doctor–patient–society relationship is undergoing a progressively dangerous phase of distrust leading to increased violence against doctors. Especially after the spread of coronavirus disease pandemic in December 2019 (COVID-19), giving an altogether new dimension to it. The tragic suicide of Dr Archana Sharma has brought doctor–patient relationship into focus, whether positive? Or negative? Who is to decide? Over the last 2 decades, the trust which was gained over centuries and cultivated the relationship of doctors and their patients has started eroding and has been demonized during COVID-19 pandemic outbreak.