ArticleClinical research in cardiology : official journal of the German Cardiac Society2023
Real-world comparative effectiveness of ARNI versus ACEi/ARB in HF with reduced or mildly reduced ejection fraction.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed, 14 citations in OpenAlex.
- Unveiling a novel pathway: Ginseng vanillic acid fights heart failure by coupling mitophagy to pyroptosis through the PINK1-BRCA1-NLRP3 axis.Journal of ginseng research · 2026Article
- Angiotensin receptor-neprilysin inhibitors improve the outcome of lung cancer patients with hypertension undergoing immune checkpoint inhibitors treatment.BMC cardiovascular disorders · 2025Article
- Improvements in medical therapy and prognosis for patients with HFrEF following the 2021 ESC HF guidelines.ESC heart failure · 2025Article
- Developing a risk score for B-type natriuretic peptide (BNP) ≥ 100 pg/ml levels: the suita study.BMC cardiovascular disorders · 2025Article
- Patterns of use and dose optimization of renin-angiotensin system modulators among chronic heart failure patients with reduced ejection fraction in resource-limited settings: a multicenter cohort study.Therapeutic advances in chronic disease · 2025Article
- SGLT-2 inhibitors and mortality among patients with heart failure with reduced ejection fraction: linked database study.BMJ (Clinical research ed.) · 2024Article
- Latest pharmaceutical approaches across the spectrum of heart failure.Heart failure reviews · 2024Review
- Renin-Angiotensin-Aldosterone System: From History to Practice of a Secular Topic.International journal of molecular sciences · 2024Review
- Estimating the clinical and budgetary impact of using angiotensin receptor neprilysin inhibitor as first line therapy in patients with HFrEF.ESC heart failure · 2024Article
- Sodium-glucose cotransporter 2 inhibitors are associated with reduced risk of mortality and readmissions in heart failure.ESC heart failure · 2024Article
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsSacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) with a class-1 guideline recommendation. We assessed the real-world effectiveness of ARNI versus angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) on all-cause and cardiovascular (CV)-related mortality and hospitalizations in heart failure (HF) with reduced or mildly reduced ejection fraction (EF).
methodsPatient-level clinical, laboratory, drug dispensation, hospitalization, and mortality data were derived from the Swedish Heart Failure Registry (SwedeHF) and interlinked databases (1 April 2016-31 December 2020). Eligible ARNI:ACEi/ARB patients (n = 7275:24,604) had a left ventricular EF < 50%. Mortality and hospitalizations with ARNI (≤ 3 months pre-/post-1 April 2016 index [SwedeHF]; n = 1506) versus ACEi/ARB (≤ 3 months post-index; n = 17,108) were assessed using propensity score matching (1:1 ratio) with clinical variables, and sensitivity analysis (1:2/1:3 with, and 1:2 without clinical variables).
resultsARNI induced a 23% reduction in all-cause mortality versus ACEi/ARB (1:1 hazard ratio [HR; 95% confidence interval (CI)]: 0.77 [0.63-0.95], p = 0.013), and a non-significant 23% relative risk reduction in CV-related mortality (0.77 [0.54-1.09], p = 0.13), but no difference in all-cause or CV-related hospitalization (1.02 [0.91-1.13]; p = 0.76; 1.01 [0.91-1.15]; p = 0.84, respectively). Sensitivity analyses confirmed all-cause mortality was reduced for ARNI versus ACEi/ARB (HR 0.90 [95% CI 0.82-0.99], p = 0.026), but not CV-related mortality (HR 1.04 [95% CI 0.89-1.22], p = 0.63).
conclusionsIn this nationwide real-world study including a population of patients with HF with reduced or mildly reduced EF, ARNI as part of guideline-led Swedish clinical practice was associated with a statistically significant relative risk reduction in all-cause mortality compared with ACEi/ARB.
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