Sacubitril/valsartan did not reduce the risk of developing atrial fibrillation compared to ACEIs/ARBs (OR 1.091; 95% CI 0.917-1.298; p=0.324).
Meta-Analysis (n=21,586)
Does sacubitril/valsartan reduce the incidence of atrial fibrillation compared to ACEIs/ARBs in patients with heart failure?
In a meta-analysis of 11 trials, sacubitril/valsartan did not significantly reduce the incidence of atrial fibrillation or atrial flutter compared to ACE inhibitors or ARBs.
Effect estimate: OR 1.091 (95% CI 0.917-1.298)
Absolute Event Rate: 2.48% vs 2.53%
p-value: p=.324
INTRODUCTION: 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. METHODS: 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. RESULTS: A total of 11 trials including 11,458 patients on sacubitril/valsartan and 10,128 patients on ACEI/ARBs were identified. A total of 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 odds ratio OR = 1.091, 95% confidence interval CI = 0.917-1.298, p = .324). Six atrial flutter (AFl) events were reported in six 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 = .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 = .337). CONCLUSION: Although sacubitril/valsartan reduces mortality compared to ACEIs/ARBs in HF patients, they do not reduce AF risk compared to these drugs.
Mohammad et al. (Sun,) conducted a meta-analysis in Heart failure (n=21,586). Sacubitril/valsartan vs. ACEIs/ARBs was evaluated on Incidence of atrial fibrillation (OR 1.091, 95% CI 0.917-1.298, p=.324). Sacubitril/valsartan did not reduce the risk of developing atrial fibrillation compared to ACEIs/ARBs (OR 1.091; 95% CI 0.917-1.298; p=0.324).