September 1, 2022Journal of Innovations in Cardiac Rhythm ManagementOpen Access

ARNIs cut sudden cardiac death and ventricular arrhythmias by ~29% vs ACEIs/ARBs in HF.

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Heart Failure (n=18548). Intervention: Angiotensin receptor-neprilysin inhibitors (ARNIs) vs. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs). Primary outcome: Composite outcome of sudden cardiac death and ventricular arrhythmias (OR 0.71, 95% CI 0.54-0.93, p=0.01).

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Why the study?

With the increasing use of ARNI for HFrEF and HFpEF, the impact of ARNI therapy on arrhythmogenesis and sudden cardiac death needed assessment.

Does ARNI therapy reduce the composite of sudden cardiac death and ventricular arrhythmias in patients with heart failure compared to ACEI/ARB therapy?

Population

18,548 patients with HFrEF and HFpEF across 10 studies

Comparison

ARNI therapy vs ACEI/ARB

Design

Systematic review and meta-analysis of 6 RCTs and 4 observational studies

Follow-up

Median 15 months

Key result

Angiotensin receptor-neprilysin inhibitors significantly reduced the composite outcome of sudden cardiac death and ventricular arrhythmias compared to ACEIs/ARBs in patients with heart failure (OR 0.71).

Authors

HMHata MujadzicPrisma Health GPGeorge ProusiPhoenixville Hospital RNRebecca NapierPrisma Health

Discussion

Member takes

Overview

Supports ARNI preference in HF to lower SCD/VA risk; extends meta-analytic evidence to arrhythmic endpoints.

Study Design

Type

Meta-Analysis (n=18,548)

Structured PICO

Does ARNI therapy reduce the composite of sudden cardiac death and ventricular arrhythmias in patients with heart failure compared to ACEI/ARB therapy?

Population

18,548 adult patients (>18 years) with heart failure (HFrEF or HFpEF) pooled from 10 studies (6 RCTs, 4 observational). Mean age 66.7, 72.7% male. Mean LVEF 33.3%. 60.2% had ischemic cardiomyopathy and 67.3% had NYHA class II symptoms.

Intervention

Angiotensin receptor-neprilysin inhibitor (ARNI) therapy

Comparator

Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) therapy

Outcome

Composite of sudden cardiac death (SCD) and ventricular arrhythmias (including ventricular tachycardia and ventricular fibrillation)composite

Main Result

Effect estimate: OR 0.71 (95% CI 0.54-0.93)

Absolute Event Rate: 3.34% vs 4.49%

p-value: p=0.01

ARNI therapy significantly reduces the composite of sudden cardiac death and ventricular arrhythmias, driven primarily by a reduction in sudden cardiac death, compared to ACEI/ARB therapy in patients with heart failure.

Limitations

Under-reporting or inaccurate identification of ventricular arrhythmic events
Inconsistent terminology regarding whether tachycardia was explicitly ventricular
Studies did not separate events in terms of sustained or non-sustained ventricular tachycardia
Inclusion of observational studies with possible ascertainment bias
Use of anti-arrhythmic therapy was not reported in all studies
Inconsistent terminology regarding tachycardia
Lack of separation between sustained and non-sustained VT
Possible ascertainment bias in observational studies
Anti-arrhythmic therapy use not reported in all studies

Cite This Study

Mujadzic et al. (2022) conducted a meta-analysis in Heart Failure (n=18,548). Angiotensin receptor-neprilysin inhibitors (ARNIs) vs. Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) was evaluated on Composite outcome of sudden cardiac death and ventricular arrhythmias (OR 0.71, 95% CI 0.54-0.93, p=0.01). Angiotensin receptor-neprilysin inhibitors significantly reduced the composite outcome of sudden cardiac death and ventricular arrhythmias compared to ACEIs/ARBs in patients with heart failure (OR 0.71).

synapsesocial.com/papers/6a0ed730aa1655e5fb22e084 https://doi.org/10.19102/icrm.2022.130905

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September 1, 2022Journal of Innovations in Cardiac Rhythm ManagementOpen Access

ARNIs cut sudden cardiac death and ventricular arrhythmias by ~29% vs ACEIs/ARBs in HF.

View Full Paper

Ask AI

Bookmark

Why the study?

With the increasing use of ARNI for HFrEF and HFpEF, the impact of ARNI therapy on arrhythmogenesis and sudden cardiac death needed assessment.

Does ARNI therapy reduce the composite of sudden cardiac death and ventricular arrhythmias in patients with heart failure compared to ACEI/ARB therapy?

Population

18,548 patients with HFrEF and HFpEF across 10 studies

Comparison

ARNI therapy vs ACEI/ARB

Design

Systematic review and meta-analysis of 6 RCTs and 4 observational studies

Follow-up

Median 15 months

Key result

Authors

HMHata MujadzicPrisma Health GPGeorge ProusiPhoenixville Hospital RNRebecca NapierPrisma Health

Discussion

Member takes

Overview

Supports ARNI preference in HF to lower SCD/VA risk; extends meta-analytic evidence to arrhythmic endpoints.

Study Design

Type

Meta-Analysis (n=18,548)

Structured PICO

Does ARNI therapy reduce the composite of sudden cardiac death and ventricular arrhythmias in patients with heart failure compared to ACEI/ARB therapy?

Population

Intervention

Angiotensin receptor-neprilysin inhibitor (ARNI) therapy

Comparator

Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) therapy

Outcome

Composite of sudden cardiac death (SCD) and ventricular arrhythmias (including ventricular tachycardia and ventricular fibrillation)composite

Main Result

Effect estimate: OR 0.71 (95% CI 0.54-0.93)

Absolute Event Rate: 3.34% vs 4.49%

p-value: p=0.01

Limitations

Under-reporting or inaccurate identification of ventricular arrhythmic events
Inconsistent terminology regarding whether tachycardia was explicitly ventricular
Studies did not separate events in terms of sustained or non-sustained ventricular tachycardia
Inclusion of observational studies with possible ascertainment bias
Use of anti-arrhythmic therapy was not reported in all studies
Inconsistent terminology regarding tachycardia
Lack of separation between sustained and non-sustained VT
Possible ascertainment bias in observational studies
Anti-arrhythmic therapy use not reported in all studies

Cite This Study

synapsesocial.com/papers/6a0ed730aa1655e5fb22e084 https://doi.org/10.19102/icrm.2022.130905

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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