New treatment for heart failure: ACE inhibitors no more the drug of choice Valsartan/sacubitril now Class I recommendation for heart failure The European Society of Cardiology (ESC) Guidelines for the diagnosis and treatment of acute and chronic heart failure have now been published in the European Heart Journal and the European Journal of Heart Failure in conjunction with their presentation at the Heart Failure 2016 and the Third World Congress on Acute Heart Failure in Florence, Italy. The 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure has been published in the Journal of the American College of Cardiology, Circulation and the Journal of Cardiac Failure. The two guidelines are broadly similar in their recommendations regarding Valsartan/sacubitril and another new heart failure drug, ivabradine. The guidelines for Valsartan/sacubitril incorporate the major findings of the pivotal PARADIGM-HF trial. The US guideline states that an ARNI (angiotensin receptor-neprilysin inhibitor) should replace an ACE inhibitor or an ARB "when stable patients with mild-to-moderate heart failure on these therapies have an adequate blood pressure and are otherwise tolerating standard therapies well." The guideline warns that Valsartan/sacubitril should not be used in addition to an ACE inhibitor or in patients with a history of angioedema. The Valsartan/sacubitril drug should replace ACEIs in patients who fit the PARADIGM-HF criteria. The Valsartan/sacubitril gained a class 1 recommendation. Ivabradine gained a class IIa recommendation to reduce heart failure hospitalization for patients with symptomatic heart failure who are already received recommended treatments, "including a beta blocker at maximum tolerated dose, and who are in sinus rhythm with a heart rate of 70 bpm or greater at rest.