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

The study's findings, published in the Clinical Research in Cardiology, align with the mortality results of the randomized trial, PARADIGM-HF. However, no difference was seen in the hospitalization rate in real-world treatment with angiotensin receptor–neprilysin inhibitor (ARNI) versus angiotensin receptor blocker/angiotensin-converting enzyme inhibitor(ACEi/ARB) in Sweden.

"Our findings are timely to boost the understanding of ARNI's effectiveness in routine clinical practice in Sweden in line with the 2021 update to the ESC HF guideline, in which ARNI is recommended for HFrEF and HFmrEF management," Michael Fu, University of Gothenburg, Gothenburg, Sweden, and colleagues wrote in their study.

Sacubitril/valsartan is a first-in-class ARNI with a class-1 guideline recommendation. The research team assessed the real-world effectiveness of ARNI compared to ACEi/ARB on hospitalization and all-cause and cardiovascular (CV)-related mortality in heart failure with reduced or mildly reduced ejection fraction.

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