Angiotensin Receptor-Neprilysin Inhibitors in Concurrent Heart Failure with Reduced Ejection Fraction and Kidney Failure

Figure 1. Weighted Kaplan–Meier curves for the primary and secondary outcomes. After IPTW, individuals on ARNI demonstrated a decreased risk of the primary outcome (a composite of all‐cause mortality and any hospitalization) and the secondary outcomes (individual all‐cause mortality, any hospitalization and cardiovascular mortality) compared with those on RAS blockers in patients with concomitant HFrEF and kidney failure receiving replacement therapy. ARNI, angiotensin receptor‐neprilysin inhibitor; CI, confidence interval; HFrEF, heart failure with reduced ejection fraction; IPTW, inverse probability of treatment weighting; RAS, renin‐angiotensin system.

Figure 2. Subgroup analyses for the primary outcome. The forest plot displays hazard ratios for the primary outcome—a composite of all‐cause mortality and any hospitalization at 2 years—comparing ARNI to RAS blockers across predefined subgroups in patients with HFrEF and kidney failure receiving replacement therapy. Generally, ARNI is associated with a lower risk of adverse outcomes across various subgroups, with no significant interaction observed between treatment effects and the subgroups analysed. ARNI, angiotensin receptor‐neprilysin inhibitor; CI, confidence interval; HFrEF, heart failure with reduced ejection fraction; RAS, renin‐angiotensin system.

Figure 3. Summary of the study. In this real‐world study of patients with HFrEF and kidney failure on replacement therapy, the use of ARNI was associated with a significant reduction in the risk of all‐cause mortality and any hospitalization compared with RAS blockers. These benefits were particularly evident in patients who adhered well to their medication. ARNI, angiotensin receptor‐neprilysin inhibitor; CI, confidence interval; HFrEF, heart failure with reduced ejection fraction; HR, hazard ratio; RAS, renin‐angiotensin system.