ArticleESC heart failure2025
Angiotensin receptor-neprilysin inhibitor adherence and outcomes in heart failure with reduced ejection fraction.
Article in ESC heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05329727 (The Comparative Effectiveness Study Between ARNI and ACE Inhibitor/ARB Medication in Patient With Heart Failure With Reduced Ejection Fraction Using the Nationwide Population Based Real World Registry of Korean Heart Failure), which is not on this map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Comparative Effectiveness Study Between ARNI and ACE Inhibitor/ARB Medication in Patient With Heart Failure With Reduced Ejection Fraction Using the Nationwide Population Based Real World Registry of Korean Heart Failure
Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Ten years real-world experience with sacubitril/valsartan in patients with heart failure with reduced ejection fraction.ESC heart failure · 2026Pooled it
- Heart Failure in the Modern Era: A Narrative Overview of Recent Research from 2022-2025.Journal of cardiovascular development and disease · 2025Review
- Medication adherence in patients with acutely decompensated heart failure: A cross-sectional study in the emergency department (ADHF-ED).European journal of heart failure · 2025Article
- Real-World Cost-Effectiveness of Angiotensin Receptor-Neprilysin Inhibitor in Heart Failure With Reduced Ejection Fraction in Korea.Korean circulation journal · 2025Article
- Angiotensin receptor-neprilysin inhibitors in concurrent heart failure with reduced ejection fraction and kidney failure.ESC heart failure · 2025Article
- Angiotensin receptor-neprilysin inhibitor adherence and outcomes in heart failure with reduced ejection fraction.ESC heart failure · 2025Article
- Mind the Gap: Bridging Guideline Recommendations and Real-World Practice in Heart Failure Management.International journal of heart failure · 2025Article
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Authors and funding
7 authors.
Funding
Abstract
aimsWhether medication adherence to angiotensin receptor-neprilysin inhibitor (ARNI) in real-world practice is associated with the reduced risk of all-cause mortality or hospitalization relative to that with traditional renin-angiotensin system (RAS) blockade remains unclear. This study investigated the influence of medication adherence of ARNI and traditional RAS blockade in heart failure with reduced ejection fraction (HFrEF).
methodWe conducted a nationwide longitudinal cohort study with patients with HFrEF using data from the Korean National Health Insurance Service data (2017-2021) covering the entire population. A total of 13 483 patients with HFrEF who received ARNI were matched 1:1 with 13 483 patients who received traditional RAS blockade using propensity score matching. The primary outcome was a composite of all-cause mortality or any hospitalization within one year. Medication adherence was assessed by calculating the proportion of days covered (PDC) relative to total medication prescribed. ARNI and traditional RAS blockade adherence rates were directly compared to analyse their respective associations with the primary outcome.
resultsPatients in the ARNI group had a lower rate of the primary outcome than those in the traditional RAS blockade group [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.75-0.81; P < 0.001]. Mean PDC values spanning 1 year were 92.6 ± 14.5% and 90.9 ± 17.7% in the ARNI and RAS blockade groups, respectively (P < 0.001). Among patients with PDC ≥ 80%, the risk of primary outcome was significantly lower in the ARNI group than in the RAS blockade group (HR 0.75; 95% CI 0.72-0.78; P < 0.001) while a risk reduction with ARNI was not observed among patients with PDC < 80% (HR 0.95; 95% CI 0.85-1.05; P = 0.313). The beneficial effect was more pronounced among patients with PDC ≥ 80% than that among patients with PDC < 80% (P for interaction <0.001).
conclusionsIn a real-world cohort with HFrEF, ARNI was superior to traditional RAS blockade in reducing the risk of all-cause mortality and hospitalization. The benefit of ARNI was pronounced among patients with high medication adherence but not among those with low medication adherence, highlighting the importance of adherence to ARNI treatment for HFrEF.
trial registrationPARADE-HF ClinicalTrials.gov number, NCT05329727.
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