Abstract
Background and objectiveThe recent emergence of new molecules like angiotensin receptor-neprilysin inhibitor (ARNI) has highlighted the need for an update in heart failure (HF) management, as they have proven to yield better patient outcomes compared to the traditional angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) use. This study aimed to compare HF-related hospitalization and death in patients on either ACEI/ARBs or ARNI in a local setting.MethodsThis two-arm interventional study was conducted in the cardiology and internal medicine units of a tertiary care hospital in Pakistan from July 2018 to December 2020. After enrollment, participants were randomized into two groups as per 1:1 ratio using an online research randomizer software (https://www.randomizer.org). Group A received 24/26 or 49/51 mg sacubitril/valsartan twice daily for HF. Group B received 2.5 or 5 mg enalapril twice daily. Patients were followed up for 12 months or till the development of an event.ResultsThe sacubitril/valsartan group had significantly fewer HF-related hospitalizations compared to the enalapril group (13.8% vs. 22.4%; p-value: 0.03), with a relative risk reduction (RRR) of 38.3%. The sacubitril/valsartan group had 52% RRR for HF-related deaths compared to the enalapril group.ConclusionBased on our findings, treatment with sacubitril/valsartan was superior to enalapril in reducing the risk of hospitalization and death related to HF. The magnitude of the beneficial effects of sacubitril/valsartan as compared to enalapril on cardiovascular mortality was at least as high as that of long-term treatment with enalapril.
Highlights
Heart failure (HF) is a clinical syndrome, which is characterized by the failure to maintain cardiac output necessary to meet the oxygen demands of the body due to dysfunctional cardiac muscles and neurohormonal activity [1,2]
The sacubitril/valsartan group had significantly fewer heart failure (HF)-related hospitalizations compared to the enalapril group (13.8% vs. 22.4%; p-value: 0.03), with a relative risk reduction (RRR) of 38.3%
The sacubitril/valsartan group had 52% RRR for HF-related deaths compared to the enalapril group
Summary
Heart failure (HF) is a clinical syndrome, which is characterized by the failure to maintain cardiac output necessary to meet the oxygen demands of the body due to dysfunctional cardiac muscles and neurohormonal activity [1,2]. It is a progressive condition with no cure and requires life-long management with a combination of drugs and devices to reduce morbidity. It affects approximately 40 million people worldwide and has a one-year mortality and hospitalization rate of 7.2% and 31.9%, respectively [1,3]. This study aimed to compare HF-related hospitalization and death in patients on either ACEI/ARBs or ARNI in a local setting
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