Effect of Sacubitril Valsartan on the Incidence of Atrial Fibrillation: A Meta-Analysis.

Abstract

Sacubitril/valsartan reduces all-cause mortality in heart failure (HF) patients compared to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). ACEIs/ARBs have been shown to decrease the incidence of atrial fibrillation (AF). We hypothesized sacubitril-valsartan decreases the incidence of AF compared to ACEis/ARBs. Clinicaltrials.gov was searched for trials by terms sacubitril/valsartan, entresto, sacubitril, valsartan. Randomized controlled human trials of sacubitril/valsartan reporting AF were included. Data were extracted independently by two reviewers. Data was pooled using a random effect model. Publication bias was evaluated by funnel plots. A total of 11 trials including 11,458 patients on sacubitril/valsartan and 10,128 patients on ACEI/ARBs were identified. 284 AF events were reported in the sacubitril/valsartan group compared to 256 AF events in ACEIs/ARBs. Patients on sacubitril/valsartan were as likely as patients on ACEIs/ARBs to develop AF (pooled OR=1.091, 95% CI= 0.917 - 1.298, p=0.324). 6 Atrial flutter (AFl) events were reported in 6 trials; 48 out of 9165 patients in the sacubitril/valsartan group developed AFl compared to 46 out of 8759 in ACEi/ARBs group. There was no difference in AFl risk between the two groups (pooled OR=1.028, 95% CI=0.681 - 1.553, p=0.894). Finally, sacubitril/valsartan did not reduce the risk of atrial arrhythmias (AF+AFl) compared to ACEi/ARBs (pooled OR=1.081, 95% CI= 0.922 - 1.269, p=0.337). Although sacubitril/valsartan reduces mortality compared to ACEIs/ARBs in HF patients, they do not reduce AF risk compared to these drugs. This article is protected by copyright. All rights reserved.