Clinical efficacy of angiotensin receptor-neprilysin inhibitor in de novo heart failure with reduced ejection fraction

• Published in: The Korean journal of internal medicine Vol. 38; no. 5; pp. 692 - 703
• Main Authors: Park, Su Yeong, Kong, Min Gyu, Moon, Inki, Park, Hyun Woo, Choi, Hyung-Oh, Seo, Hye Sun, Cho, Yoon Haeng, Lee, Nae-Hee, Lee, Kwan Yong, Jang, Ho-Jun, Kim, Je Sang, Choi, Ik Jun, Suh, Jon
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Association of Internal Medicine 01.09.2023; 대한내과학회
• Subjects: angiotensin receptor-neprilysin inhibitor; Antihypertensive Agents; Antiviral Agents; cardiac reverse remodeling; clinical outcome; heart failure; Heart Failure - diagnosis; Heart Failure - drug therapy; Humans; Neprilysin; Original; Retrospective Studies; Stroke Volume; Treatment Outcome; Ventricular Function, Left; worsening heart failure; 내과학; Heart failure; Clinical outcome; Worsening heart failure; Angiotensin receptor-neprilysin inhibitor; Cardiac reverse remodeling
• ISSN: 1226-3303; 2005-6648; 2005-6648
• DOI: 10.3904/kjim.2023.065

We aimed to analyze the efficacy of angiotensin receptor-neprilysin inhibitor (ARNI) by the disease course of heart failure (HF). We evaluated 227 patients with HF in a multi-center retrospective cohort that included those with left ventricular ejection fraction (LVEF) ≤ 40% undergoing ARNI treatment. The patients were divided into patients with newly diagnosed HF with ARNI treatment initiated within 6 months of diagnosis (de novo HF group) and those who were diagnosed or admitted for HF exacerbation for more than 6 months prior to initiation of ARNI treatment (prior HF group). The primary outcome was a composite of cardiovascular death and worsening HF, including hospitalization or an emergency visit for HF aggravation within 12 months. No significant differences in baseline characteristics were reported between the de novo and prior HF groups. The prior HF group was significantly associated with a higher primary outcome (23.9 vs. 9.4%) than the de novo HF group (adjusted hazard ratio 2.52, 95% confidence interval 1.06-5.96, p = 0.036), although on a higher initial dose. The de novo HF group showed better LVEF improvement after 1 year (12.0% vs 7.4%, p = 0.010). Further, the discontinuation rate of diuretics after 1 year was numerically higher in the de novo group than the prior HF group (34.4 vs 18.5%, p = 0.064). The de novo HF group had a lower risk of the primary composite outcome than the prior HF group in patients with reduced ejection fraction who were treated with ARNI.