Real-world comparative effectiveness of ARNI versus ACEi/ARB in HF with reduced or mildly reduced ejection fraction.

• Sacubitril/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).Patient-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 (≤3months pre-/post-1 April 2016 index [SwedeHF]; n=1506) versus ACEi/ARB (≤3months 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).ARNI 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 (HR0.90 [95% CI 0.82-0.99], p=0.026), but not CV-related mortality (HR1.04 [95% CI 0.89-1.22], p=0.63).In 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.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

ARNI

Effectiveness

Heart failure

Heart failure with mildly reduced ejection fraction

Heart failure with reduced ejection fraction

Real-world

Heart failure; Heart failure with reduced ejection fraction; Heart failure with mildly reduced ejection fraction; ARNI; Real-world; Effectiveness

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)