Comparative evaluation of sacubitril/valsartan and telmisartan in the management of heart failure with reduced ejection fraction: an assessment of therapeutic effectiveness and safety profile

Background: Heart failure (HF) remains a leading global cause of morbidity, hospitalizations, and mortality. Although sacubitril/valsartan has shown superior clinical outcomes compared with conventional angiotensin II receptor blockers, its higher cost and potential side effects have limited its broader use. Telmisartan, a widely prescribed and cost-effective angiotensin receptor blocker, is known for its favorable safety profile. However, direct comparisons between sacubitril/valsartan and telmisartan are limited. This study was conducted to evaluate and compare the effectiveness, safety, and cost-effectiveness of sacubitril/valsartan versus telmisartan in patients with HF with reduced ejection fraction (EF; HFrEF) within a tertiary care hospital setting. Materials and Methods: A 6-month prospective study was carried out in the Department of Cardiology at a tertiary care hospital. Data on patient demographics, echocardiographic findings, incidence of adverse drug reactions (ADRs), and treatment-related costs were collected using a structured data collection form. Results: A total of 72 patients met the inclusion criteria—33 received sacubitril/valsartan and 39 received telmisartan. The primary outcome was the change in left ventricular (LV) EF (LVEF) from baseline to the end of a 3-month follow-up. Both groups showed significant improvements in LVEF; however, the sacubitril/valsartan group showed a greater increase (mean EF = 44%) than the telmisartan group (mean EF = 38%). Safety analysis indicated no statistically significant difference in ADR incidence between the two groups. Nevertheless, the total cost of therapy was considerably higher in the sacubitril/valsartan group than in the telmisartan group. Conclusion: Sacubitril/valsartan demonstrated greater efficacy in improving EF over 3 months compared with telmisartan in patients with HFrEF. Although it is associated with higher treatment costs, the enhanced clinical benefits and favorable outcomes support its use as a superior therapeutic option for managing HFrEF.