The results of the randomized, PARADIGM-HF trial led to the insertion of the sacubitril/valsartan combination, as a replacement therapy of Angiotensin Converting Enzyme-inhibitors (ACEi) to further reduce the risk of HF hospitalization and death of patients suffering from heart failure with reduced ejection fraction and remain symptomatic despite optimal therapy. The current indication for the sacubitril/valsartan combination in this patient category is class I, with level of evidence B. In this case report we describe our own clinical experience on the remarkable clinical recovery of a patient suffering from ischemic heart failure, whose functional status deteriorated from NYHA II to NYHA IV, after his second acute coronary episode and during his index hospitalization. 42 days later and after only 4 days of the ''off-label'' initiation of the low-dose sacubitril/valsartan combination the patient exhibited remarkable clinical improvement.
Kafkas N, Dragasis S and Floros G