July 12, 2026Journal of the American Heart Association0 citationsOpen Access
View Full PaperAssociation Between Sacubitril/Valsartan Use and Risk of Major Adverse Cardiovascular Events in Patients With Durable Left Ventricular Assist Devices: A Multi‐Institutional Real‐World Cohort Study
Key Result
Among patients with durable left ventricular assist devices, ARNI therapy was associated with a lower risk of 1-year major adverse cardiovascular events (HR 0.71; 95% CI 0.60-0.83; P<0.001).
Key Points
- This research investigates the impact of ARNI therapy on major adverse cardiovascular events in patients with left ventricular assist devices.
- Multicenter retrospective cohort study using the TriNetX Research Network.
- Adults with durable left ventricular assist devices from 2015 to 2025 were included.
- Patients receiving ARNI therapy were 1:1 propensity score matched with those without ARNI exposure.
- ARNI use reduced major adverse cardiovascular events (28.8% vs 35.9%; HR 0.71, 95% CI 0.60–0.83; P <0.001).
- All-cause mortality was lower in the ARNI group (6.7% vs 10.6%; HR 0.57, 95% CI 0.41–0.78; P <0.001).
- Heart failure exacerbation rates were reduced (26.0% vs 30.2%; HR 0.76, 95% CI 0.64–0.91; P =0.002).
Study Design
Type
Cohort (n=1,846)
Multicenter
Yes
Structured PICO
Does sacubitril/valsartan reduce 1-year major adverse cardiovascular events in adults with durable left ventricular assist devices?
P
Population
1,846 adults with advanced heart failure undergoing durable left ventricular assist device implantation, propensity-matched to compare ARNI therapy versus no ARNI exposure, followed for 1 year.
E
Exposure
Sacubitril/valsartan (angiotensin receptor-neprilysin inhibitor [ARNI]) therapy
C
Comparator
No ARNI exposure (propensity score matched 1:1)
O
Outcome
1-year major adverse cardiovascular events, defined as a composite of heart failure exacerbation or all-cause mortalitycomposite
In patients with durable left ventricular assist devices, sacubitril/valsartan use is associated with a significantly lower risk of 1-year major adverse cardiovascular events, all-cause mortality, and major adverse kidney events.
Main Result
Hazard Ratio: 0.71 (95% CI 0.6–0.83)
Absolute Event Rate: 28.8% vs 35.9%
p-value: p=<0.001
Limitations
- Observational design requires confirmation in prospective studies
Abstract
Background Durable left ventricular assist devices improve survival in patients with advanced heart failure (HF), yet long‐term outcomes remain limited by recurrent decompensation and end‐organ dysfunction. Evidence on the prognostic association of angiotensin receptor–neprilysin inhibitor (ARNI) therapy after left ventricular assist device implantation remains limited. Methods We conducted a retrospective multicenter cohort study using the TriNetX Research Network. Adults undergoing durable left ventricular assist device implantation between 2015 and 2025 were identified. Patients receiving ARNI therapy were propensity score matched 1:1 with patients without ARNI exposure. The primary outcome was 1‐year major adverse cardiovascular events, defined as a composite of heart failure exacerbation or all‐cause mortality. Secondary outcomes included all‐cause mortality, heart failure exacerbation, and major adverse kidney events hazards models estimated hazard ratios (HRs) with 95% CIs. Results After matching, 923 patients were included in each group. ARNI use was associated with significantly lower risks of major adverse cardiovascular events (28.8% versus 35.9%; HR 0.71, 95% CI 0.60–0.83; P <0.001), all‐cause mortality (6.7% versus 10.6%; HR 0.57, 95% CI 0.41–0.78; P <0.001), heart failure exacerbation (26.0% versus 30.2%; HR 0.76, 95% CI 0.64–0.91; P =0.002), and major adverse kidney events (5.1% versus 10.4%; HR 0.45, 95% CI 0.32–0.64; P <0.001). Results were consistent across prespecified subgroups and supported by negative control and E‐value analyses. Conclusions Among patients with durable left ventricular assist devices support, ARNI therapy was associated with lower cardiovascular and renal event risk. Given the observational design, these findings should be interpreted cautiously and require confirmation in prospective studies.
Cite This Study
Wu et al. (Fri,) conducted a cohort in Advanced heart failure with durable left ventricular assist devices (n=1,846). Angiotensin receptor-neprilysin inhibitor (ARNI) therapy vs. No ARNI exposure was evaluated on 1-year major adverse cardiovascular events (composite of heart failure exacerbation or all-cause mortality) (HR 0.71, 95% CI 0.60-0.83, p=<0.001). Among patients with durable left ventricular assist devices, ARNI therapy was associated with a lower risk of 1-year major adverse cardiovascular events (HR 0.71; 95% CI 0.60-0.83; P<0.001).