American Board of Internal Medicine (ABIM) Certification Practice Exam

What class of heart failure symptoms should a patient tolerate to use valsartan-sacubitril?

1. Class I or II

2. Class III or IV

3. Class V

4. Asymptomatic

The correct answer is: Class III or IV

Valentartan-sacubitril, commonly known by its brand name Entresto, is a combination medication used in the management of heart failure. It is particularly indicated for patients with chronic heart failure with reduced ejection fraction (HFrEF). Patients with Class III or IV heart failure symptoms, as defined by the New York Heart Association (NYHA) classification, would benefit from treatment with valsartan-sacubitril. Class III patients experience marked limitation in physical activity, while Class IV patients are unable to carry on any physical activity without discomfort and may have symptoms at rest. These classes represent more advanced heart failure, where the initiation of a more aggressive therapeutic approach, including the use of valsartan-sacubitril, is warranted to improve symptoms, reduce morbidity, and potentially increase survival. The other options pertain to less severe presentations of heart failure where the initiation of this specific treatment may not be necessary or is not indicated at such an aggressive level. Class I patients are asymptomatic and can perform ordinary physical activities without limitation, whereas Class II patients experience mild limitations but are generally comfortable at rest and only exhibit symptoms with significant exertion. Class V is not a recognized classification within the traditional heart failure classifications and may not have a defined treatment