Key result
Switching from RAAS inhibitors to ARNI and SGLT2 inhibitors decreased the risk of death per 100 patient-years from 12.2% to 8.9% in stable HFrEF and from 36.8% to 19.9% in decompensated HFrEF.
Why the study?
Two new drug classes, ARNI and SGLT2 inhibitors, have emerged for HFrEF, but their combined net effect compared with triple neurohormonal blockade in Russian patients with stable or decompensated CHF needed evaluation.
Does simultaneous treatment with ARNI and SGLT2 inhibitors reduce the risk of death compared to traditional triple neurohormonal blockade in patients with stable or decompensated HFrEF?
Observational
Yes
Does simultaneous treatment with ARNI and SGLT2 inhibitors reduce the risk of death compared to traditional triple neurohormonal blockade in patients with stable or decompensated HFrEF?
Effect estimate: 27% total risk decrease
Absolute Event Rate: 8.9% vs 12.2%
Number Needed to Treat: 30
Early initiation of ARNI and SGLT2 inhibitors is estimated to substantially reduce the risk of death in both stable and decompensated HFrEF patients compared to traditional RAAS inhibitor therapy.
Associated with lower mortality in stable and decompensated HFrEF; leaves open whether combined ARNI-SGLT2i therapy should replace RAAS inhibitors pending RCTs.
Major principles for treatment of chronic heart failure with reduced left ventricular ejection fraction <40% (HFrEF) include a "triple neurohormonal blockade" as a main approach. However, in recent 6 years, two new classes of drugs for the treatment of HFrEF have appeared, which beneficially influence the prognosis. These drugs are angiotensin receptor neprilysin inhibitors (ARNI) and type 2 sodium-glucose cotransporter 2 (SGLT2) inhibitors.Aim To compare the net effect of simultaneous treatment with ARNI and SGLT2 inhibitors with the triple neurohormonal blockade in stable or decompensated patients with CHF based on Russian data.Material and methods We analyzed the risk of death per 100 patient-years in patients with HFrEF. Stable patients were followed up at the A.L. Myasnikov Institute of Cardiology (presently, A.L. Myasnikov Research Institute of Clinical Cardiology of the National Medical Research Center of Cardiology) from 2006 through 2007; data from the EPOCH-Decompensation-CHF study were used for decompensated patients (12.2 % and 36.8 %, respectively).Results When patients with stable HFrEF were successively switched from renin-angiotensin-aldosterone system (RAAS) inhibitors to ARNI (-16 %) and subsequently supplemented with SGLT2 (-13 %) the risk of death per 100 patient-years decreased from 12.2 % to 8.9 % (total risk decreased by 27 %; to save one patient the ARNI+ SGLT2 combination has to be prescribed to 30 patients). The estimated risk of death upon discharge from the hospital for the patients with decompensated CHF switched from RAAS inhibitors to ARNI (-16 %) and subsequently supplemented with SGLT2 (-13 %) was 26.9 deaths per 100 patient-years, whereas the number of patients to be treated for saving one life was only 10. Based on available data that demonstrate a greater effect of ARNI+ SGLT2 in patients immediately after CHF aggravation, the risk of death was recalculated. According to this analysis, the death rate per 1000 patient-years decreased from 36.8 to 19.9 % (relative risk decrease, 46 %), and to save one life only 6 patients had to be treated after they have achieved compensation of HFrEF.Conclusions This analysis shows the importance of early initiation of the ARNI+ SGLT2 therapy in patients with both decompensated and with stable HFrEF.
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Mareev et al. (2021) conducted an observational in Chronic heart failure with reduced left ventricular ejection fraction <40% (HFrEF). ARNI and SGLT2 inhibitors vs. RAAS inhibitors was evaluated on Risk of death per 100 patient-years (27% total risk decrease). Switching from RAAS inhibitors to ARNI and SGLT2 inhibitors decreased the risk of death per 100 patient-years from 12.2% to 8.9% in stable HFrEF and from 36.8% to 19.9% in decompensated HFrEF.
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