Sacubitril/valsartan (ARNI) reduces cardiovascular mortality and HF hospitalizations in HFrEF and cuts recurrent hospitalizations, especially in women with preserved EF.
Does sacubitril/valsartan reduce cardiovascular mortality and heart failure hospitalizations in patients with chronic heart failure compared to conventional ACE inhibitors?
This systematic review reinforces sacubitril/valsartan as a cornerstone of guideline-directed medical therapy across the heart failure spectrum, highlighting mortality and hospitalization benefits in HFrEF and hospitalization reductions in HFpEF/HFmrEF.
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Angiotensin receptor–neprilysin inhibitors (ARNI), with sacubitril/valsartan as the prototypical agent, have fundamentally transformed the pharmacological treatment paradigm of chronic heart failure (HF) 6,11,36,47,48,49,50. This systematic review synthesizes the available clinical evidence, with a particular focus on the therapeutic efficacy of ARNI across the full continuum of left ventricular ejection fraction 3,4,17,50. In patients with heart failure with reduced ejection fraction (HFrEF), pivotal randomized trials have consistently demonstrated the superiority of ARNI over conventional angiotensin-converting enzyme inhibitors in lowering cardiovascular mortality and HF-related hospitalizations, while also promoting favorable reverse myocardial remodeling 2,9,10,11,18,26,30,39,41,43,44,49. In contrast, among individuals with preserved or mildly reduced ejection fraction, the principal clinical benefit is reduction in recurrent HF hospitalizations, with numerically greater treatment effects reported in women 1,3,7,18,23. In addition, sacubitril/valsartan exhibits clinically relevant renoprotective effects and a favorable safety profile in complex patient populations, including those with diabetes mellitus or advanced chronic kidney disease 4,10,11,18. Contemporary clinical guidelines position ARNI as a cornerstone of quadruple guideline-directed medical therapy, recommending early initiation during hospitalization and proactive dose up-titration to optimize clinical outcomes 7,8,11,13,21,31,47,48,49,50. Addressing barriers to implementation—such as treatment-related hypotension and therapeutic inertia—remains essential to reduce the considerable global burden of heart failure 5,7,28,29,34,38.
Schulz et al. (Fri,) reported a other. Sacubitril/valsartan (ARNI) reduces cardiovascular mortality and HF hospitalizations in HFrEF and cuts recurrent hospitalizations, especially in women with preserved EF.