The Consumer’s Guide to Angiotensin-Receptor Neprilysin Inhibitors (ARNIs) for Heart Failure

Learn more about a new first-in-class medication for people with heart failure.

M ore than 6 million adults in the United States have heart failure. Of these, about half have diastolic heart failure and the other half have systolic heart failure.

In February 2021, the U.S. Food and Drug Administration (FDA) approved a new class of medications called angiotensin receptor–neprilysin inhibitors (ARNI) for people with certain types of diastolic heart failure — the first time a treatment was approved for this condition. ARNIs have also been approved to treat systolic heart failure since 2015.

If you’ve been diagnosed with heart failure but haven’t found a treatment that has helped ease your symptoms, you may want to ask your doctor about ARNIs. Use this guide to learn more about this medication, including whether you may be a candidate.

How ARNIs Work

7 Essential Facts About ARNIs for Heart Failure

Should I Take an ARNI for Heart Failure?

If you’ve been diagnosed with heart failure with reduced (40 percent or lower) or preserved ejection fraction, you may be a candidate for an ARNI.

You may also benefit from an ARNI if you’re currently taking another heart failure medication but aren’t getting the results you’d like or are bothered by the side effects — for instance, if you’re taking an ACE inhibitor and coughing a lot.

Some people aren’t candidates for the medication, though. This includes people who are pregnant, planning on becoming pregnant, or breastfeeding, because this type of drug can be toxic to fetuses and babies.

Because these drugs can lower blood pressure levels, people with very low blood pressure due to kidney disease, liver disease, or other conditions may not be able to take an ARNI. You also shouldn’t take it if you’re allergic to any of its ingredients or you’ve experienced angioedema while taking an ACE inhibitor or ARB. If you’re taking an ACE inhibitor and want to switch, you’ll need a three-day washout period before starting the ARNI. Lastly, people with diabetes who are taking aliskiren should avoid ARNIs.

4 FAQs About ARNIs

Next Steps: Making the Decision to Take an ARNI for Heart Failure



Now that you've learned more about ARNIs, ask yourself these questions to determine if the medication is right for you.


  1. Are you satisfied with your current heart failure treatment?
  2. Has your current medication improved your symptoms as much as you’d hoped?
  3. Are you coughing a lot when taking an ACE inhibitor or having other bothersome side effects from your medication?
  4. How much has heart failure affected your quality of life?
  5. How often do you have to cancel or end activities early because of your condition?
  6. Have you tried other treatments for heart failure?

Doctor Discussion

  1. Do you think I can gain better control of my heart failure?
  2. What medications do you recommend for heart failure, and why?
  3. Am I a good candidate for an ARNI?
  4. What results can I expect from an ARNI?
  5. What side effects should I be aware of?
  6. Are there contraindications I should know about?
  7. How will this medication affect my kidneys?
  8. Will I have to get follow-up blood work after I start this medication?
  9. What other things can I do to help treat my heart failure?