Angiotensin Receptor Neprilysin Inhibitor Therapy Improves Ejection Fraction in Patients with Systolic Heart Failure

Abstract

Introduction The PARADIGM-HF study showed that angiotensin receptor-neprilysin inhibitor (ARNI) therapy with sacubitril/valsartan significantly reduced cardiovascular mortality, heart failure hospitalization, and all-cause mortality compared to ace inhibitor therapy with enalapril in patients with heart failure with reduced ejection fraction (HFrEF). Since being fast tracked for HFrEF treatment in 2015, ARNI has been studied in various aspects related to efficacy and long-term effects. However, the effect of ARNI specifically on ejection fraction (EF) in patients with HFrEF on guideline directed medical therapy (GDMT) remains unknown. Hypothesis Given preliminary data, our hypothesis is that patients with heart failure on GDMT will show significant recovery and improvement in EF after initiating ARNI therapy. Methods A retrospective chart review was conducted to identify all patients treated with ARNI at a dedicated heart failure clinic in the past 12 months meeting the following criteria: (i) age ≥ 18 years, (ii) NYHA class II-III symptoms, (iii) on GDMT (beta blocker, ace inhibitor/angiotensin receptor blocker, and aldosterone antagonist) prior to ARNI initiation, (iv) EF ≤35% at time of ARNI initiation, (v) HFrEF on echo for ≥6 months prior to ARNI initiation, and (vi) follow up echo >3-6 months after ARNI initiation. Interval changes in EF since starting ARNI were compared changes in EF prior to starting ARNI. Results Patients started on ARNI showed significant recovery and improvement in EF at an average follow up of 6 months compared to EF at time of ARNI initiation (32.7% vs 22.6%, respectively, p = 0.0013). Conclusions ARNI therapy shows significant improvement and recovery of EF in patients with HFrEF on GDMT. These findings suggest that ARNI therapy could potentially reduce or delay the necessity for defibrillators and other costly procedures, while also contributing to decreased rates of hospitalizations and overall morbidity and mortality of patients with systolic heart failure.