ARNI linked with reduced risk of all-cause mortality in patients with HFrEF or HFmrEF: Study

For this purpose, the researchers derived patient-level clinical, drug dispensation, mortality, hospitalization, and laboratory data from interlinked databases and the Swedish Heart Failure Registry (SwedeHF). They assessed hospitalization and mortality with ARNI (n=1506) versus ACEi/ARB (n = 17,108) using propensity score matching in the ratio of 1:1 with sensitivity analysis and clinical variables. Eligible ARNI (n=7275) versus ACEi/ARB patients (n=24,604) had a left ventricular EF < 50%.

The study led to the following findings:

• ARNI led to a 23% reduction in all-cause mortality compared to ACEi/ARB (1:1 hazard ratio [HR]: 0.77) and a non-significant 23% relative risk reduction (RR) in CV-related mortality (0.77), but no difference was seen in all-cause or CV-related hospitalization (1.02; 1.01 respectively).
• Sensitivity analyses confirmed a reduction in all-cause mortality for ARNI versus ACEi/ARB (HR 0.90) but not CV-related mortality (HR 1.04).

In the nationwide real-world study, comprising a population of patients with HF with reduced or mildly reduced EF, ARNI as part of guideline-led Swedish clinical practice was linked with a statistically significant relative RR in all-cause mortality compared with ACEi/ARB.

Reference:

Fu, M., Pivodic, A., Käck, O. et al. Real-world comparative effectiveness of ARNI versus ACEi/ARB in HF with reduced or mildly reduced ejection fraction. Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02124-w