1. We recommend that in patients with mild to moderate heart failure (HF), an EF ≤ 40%, an elevated natriuretic peptide (NP) level or hospitalization for HF in the past 12 months, a serum potassium < 5.2 mmol/L and an eGFR ≥ 30 mL/min and treated with appropriate doses of guideline-directed medical therapy should be treated with LCZ696 in place of an ACE inhibitor or an angiotensin receptor blocker, with close surveillance of serum potassium and creatinine (Conditional Recommendation, High-Quality Evidence).

Values and Preferences: This recommendation places high value on medications proven in large trials to reduce mortality, HF rehospitalization and symptoms. It also considers the health economic implications of new medications. The recommendation is conditional because the drug is not yet approved for clinical use in Canada and the price is still not known.