Discussion
hyperkalaemia, angioedema, hypotension
DISEASES, ANGIOEDEMA
Despite a significant improvement in the management of HFrEF in recent years, it remains the major cause of morbidity and mortality in cardiac patients. With the favorable results from various clinical trials [In the PARADIGM-HF study hypotension was the leading safety concern among South Asian HF patients received Sacubitril/Valsartan with the incidence rate of 10.5% followed by hyperkalaemia in 8.9%, and angioedema in 0.3% [Findings of our study reading tolerability of Sacubitril/Valsartan in our population are reassuring with more than 80% tolerability similar to the TITRATION study where tolerability success was achieved in 85.2% of the patients treated with Sacubitril/Valsartan [Some of the recent studies have demonstrated safety and efficacy Sacubitril/Valsartan in real-life study of patients with HFrEF. A study conducted by Armentaro et al. [Even though, this is the first prospective clinical study in Pakistani population, single center experience, lack of control group, and limited sample size remained the main limitation of our study. The short duration of follow-up remained another important limitation considering the chronic nature of the diseases. Additionally, in real-life clinical practice HFrEF patients generally present with multiple co-morbid conditions, hence, exclusion of low eGFR, low BP, low hemoglobin, and CRT/ICD treatment may limit the generalizability of study findings. Further large scale multicenter randomized studies with longer follow-up duration are needed to elaborate the role of Sacubitril/Valsartan in HFrEF patients of Pakistani population.