An 80-year-old woman with heart failure (LVEF 35%) and CKD stage 3b (eGFR 38) is currently on Ramipril 10 mg, Bisoprolol 10 mg, Furosemide 40 mg, and ...

Question

An 80-year-old woman with heart failure (LVEF 35%) and CKD stage 3b (eGFR 38) is currently on Ramipril 10 mg, Bisoprolol 10 mg, Furosemide 40 mg, and Spironolactone 25 mg. She remains symptomatic (NYHA II-III). Her cardiologist considers switching Ramipril to Sacubitril/Valsartan. What is the key requirement BEFORE starting Sacubitril/Valsartan?

Accepted Answer

Ramipril must be stopped for at least 36 hours before starting Sacubitril/Valsartan to reduce the risk of angioedema

Answer

Ramipril can be switched directly to Sacubitril/Valsartan on the same day

Answer

An echocardiogram must be performed immediately before switching

Answer

Her eGFR must be above 60 before the switch

Answer

Spironolactone must be stopped first

uk-dgm MCQ (SBA): Sacubitril/Valsartan - ACEi Washout Period