Heart Failure — RACP Adult Medicine MCQ

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ModerateCardiologyHeart FailureRACP Adult Medicine

A 78-year-old woman with known HFrEF (LVEF 28%) is being considered for sacubitril/valsartan. She is currently on ramipril 10 mg daily. What is the minimum washout period required before commencing sacubitril/valsartan?

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Correct answer: A — 36 hours

A minimum 36-hour washout period from ACE inhibitors is required before commencing sacubitril/valsartan to reduce the risk of angioedema. This is due to the dual inhibition of neprilysin and ACE, which leads to excessive bradykinin accumulation. No washout is required when switching from an ARB.

Reference: AMH – 2025 – Neprilysin inhibitors; eTG – 2025 – Cardiovascular