It is indicated to reduce the risk of CV death and hospitalization for heart failure in patients with HFrEF (NYHA Class II-IV). As per the ACC/AHA and ESC Guidelines 2016, replacement by an ARNi is recommended in patients with chronic symptomatic HFrEF NYHA Class II or III who tolerate an ACEI or ARB, to further reduce morbidity and mortality.

ARNi should not be co-administered with ACEI or within 36 hours of the last dose of an ACEI because of risk of angioedema and should not be administered to patient with a history of angioedema. Hypotension, angioedema, worsening renal functions and hyperkalemia are infrequent untoward effects.