Introduction: Cardiac sarcoidosis [CS] is an important manifestation of sarcoidosis, which can lead to heart failure with reduced ejection fraction [HFrEF] and potentially life-threatening arrhythmias (1). Angiotensin receptor-neprilysin inhibitors [Sacubitril/Valsartan, ARNIs] are established treatment for HFrEF (2, 3), however, the evidence base for efficacy of ARNIs in CS is limited. 

Objectives: This study aims to provide a real-world experience of ARNI prescribing from a specialist cardiac sarcoidosis nurse-led clinic at a tertiary cardiac centre. 

Materials and Methods: This is a single centre, retrospective, observational cohort study of CS patients with HFrEF reviewed between July 2025 and March 2026 for optimisation of heart failure medical therapy.  

Results: Seventeen patients were reviewed, four still undergoing ARNI titration were excluded. Mean age was 58.6yrs, nine (69%) were male. Cardiovascular risk factors were hypertension (15%), chronic kidney disease (23%) and type-2 diabetes mellitus (31%), arrhythmia was prominent: 8 patients (62%) had ventricular tachycardia, and 1 patient (8%) had atrial fibrillation. Nine (69%) were on Methotrexate.

Heart failure medication was reasonably tolerated, nine patients (69%) were on all four-pillars (Beta Blocker, Mineralocorticoid Receptor Antagonist, Sodium-Glucose Cotransporter-2 Inhibitor, ARNI), ten patients (77%) tolerated ARNI. Three patients (23%) tolerated maximum ARNI dose of 200mg twice daily, whilst 7 (54%) tolerated middle or lowest dosages. Adverse drug reactions occurred in 10 patients (77%), resulting in 8 patients (80%) reducing ARNI dose and 2 patients (20%) ceasing ARNI: hypotension was most common (90%), deteriorating renal function (10%) and diarrhoea (10%). There were zero deaths and one hospitalisation.

Serial echocardiography showed minimal cardiac function improvement (Figure 1), LVEF changed by +1.72% and RV FAC by +9.77%.

Conclusions: The nurse-led clinic demonstrated ARNIs can be safely introduced in CS patients. Although this did not translate into meaningful improvement of cardiac function, potentially due to small cohort size and/or short follow-up duration. Further multi-centre registry study is required.