The document is a practical recommendation paper based on a series of advisory board meetings held by a group of cardiologists in India to discuss the use of ARNI in the management of heart failure.

The document emphasizes the importance of implementing guideline-directed medical therapy (GDMT) for heart failure, as there is insufficient implementation of GDMT according to the National Heart Failure Register.

The recommendations cover several aspects of heart failure management, including biomarkers, imaging, initiation and titration of guideline-directed therapy, the role of ARNI in HFrEF, HFpEF, and HFmrEF, dose titration, and in-hospital initiation of ARNI.

The use of ARNI in heart failure is supported by clinical trials and guidelines, with ARNI being one of the four medications recommended for treating heart failure with reduced ejection fraction (HFrEF).

ARNIs can improve diastolic and left ventricular function, quality of life, and reduce the risk of ventricular arrhythmias.