Observational studyBMJ open2026
Association between angiotensin receptor-neprilysin inhibitor use and clinical outcomes in patients with heart failure: a 1-year prospective cohort study from Jordan.
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
objectivesHeart failure (HF) is associated with complex symptoms and frequent hospitalisation that reduce patients' quality of life (QoL). This study aims to assess the association between angiotensin receptor-neprilysin inhibitor (ARNI) use and changes in QoL and disease-related outcomes among patients with HF in Jordan.
designProspective observational cohort study. SETTING AND
participantsThe study was conducted among patients with HF attending the outpatient cardiology clinics at Jordan University Hospital, a tertiary care centre in Amman, Jordan. Patients either initiated on ARNI or receiving angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) were included in the study at a 1:2 ratio. All participants were followed up for up to 1 year after recruitment. The study period was from 4 February 2024 to 29 May 2025. PRIMARY AND SECONDARY OUTCOME MEASURES: Data on QoL, New York Heart Association (NYHA) functional class and left ventricular ejection fraction (LVEF) were collected at baseline and after 3 months of treatment. Hospitalisation data were collected for the preceding year and the year following participants' recruitment. Medication adherence and ARNI side effects were assessed after 3-month of follow-up period.
resultsA total of 227 patients with HF were included; 74 were initiated on ARNI, and 153 were receiving ACEIs/ARBs. At baseline, significantly lower QoL scores and LVEF were observed in the ARNI group compared with the ACEIs/ARBs group. After 3-month, the ARNI group showed improvements in all QoL scores, NYHA functional class and LVEF (p<0.05). Worsened QoL scores (symptom stability, symptom burden, self-efficacy domains and clinical summary score) were detected within the ACEIs/ARBs group (p<0.05). One-year post-recruitment a significant reduction in cardiovascular and all-cause hospitalisations (p<0.05) was observed in the ARNI group compared with the ACEIs/ARBs group. Adherence levels assessed after 3 months of treatment were shown to be high in both study groups (p=0.558). The main ARNI side effect was hypotension.
conclusionsARNI use was associated with favourable QoL, NYHA class, and LVEF as well as lower hospitalisation rates among patients with HF in Jordan. The safety profile was consistent with previous studies.
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