Key result
Initiation of ARNI after stabilization of acute decompensated heart failure significantly reduced HF rehospitalization or all-cause mortality compared to ACEIs/ARBs (RR 0.71; 95% CI 0.57-0.88; p<0.01).
Why the study?
Although ARNI is well-established for chronic HFrEF, its efficacy and safety when initiated during acute decompensated heart failure remain less well characterized.
Does the initiation of ARNI reduce heart failure rehospitalization or all-cause mortality compared to ACEIs/ARBs in patients with stabilized acute decompensated heart failure?
Meta-Analysis (n=1,741)
Does the initiation of ARNI reduce heart failure rehospitalization or all-cause mortality compared to ACEIs/ARBs in patients with stabilized acute decompensated heart failure?
Initiation of ARNI after stabilization of acute decompensated heart failure significantly reduces HF rehospitalization and all-cause mortality compared to ACEIs/ARBs, though it increases the risk of symptomatic hypotension.
Answers are grounded in this paper and cite their sources.
Supports ARNI initiation after ADHF stabilization; extends chronic HFrEF benefits to this acute setting.
Purpose Angiotensin receptor-neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety when initiated in acute decompensation (ADHF) remain less well characterized. This meta-analysis evaluates the efficacy and safety of ARNI compared to angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for ADHF. Methods A meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, Scopus, WOS, Embase, and CENTRAL till November 2024. Risk ratios (RR) were applied for dichotomous outcomes and standardized mean differences (SMD) for continuous outcomes, both with 95% confidence intervals (CI). Results Three RCTs with 1,741 patients were included. Use of ARNI after stabilization of ADHF resulted in a significant reduction of HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57 to 0.88; p < 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57 to 0.93; p = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64 to 1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; p < 0.0001) or 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; p = 0.0001). However, ARNI was associated with a higher risk of symptomatic hypotension (RR: 1.33; 95% CI: 1.04 to 1.71; p = 0.024). Conclusion Pooled data demonstrate that the initiation of ARNI post-ADHF can be effective compared with ACEIs/ARBs for both cardiovascular and renal benefits at the expense of increased risk for symptomatic hypotension.
No takes yet. Share an insight, caveat, or question.
Hunjul et al. (2025) conducted a meta-analysis in Acute decompensated heart failure (ADHF) (n=1,741). Angiotensin receptor-neprilysin inhibitors (ARNI) vs. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) was evaluated on HF rehospitalization/all-cause mortality (RR 0.71, 95% CI 0.57 to 0.88, p=< 0.01). Initiation of ARNI after stabilization of acute decompensated heart failure significantly reduced HF rehospitalization or all-cause mortality compared to ACEIs/ARBs (RR 0.71; 95% CI 0.57-0.88; p<0.01).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: