Key result
ARNI plus dapagliflozin is linked to ~71% lower long-term cardiac mortality versus ARNI monotherapy.
Why the study?
Although both sacubitril/valsartan and dapagliflozin reduce rehospitalization and cardiac mortality in HFrEF, the long-term cardiac and all-cause mortality of their combination versus sacubitril/valsartan monotherapy needed comparison.
Does sacubitril/valsartan combined with dapagliflozin reduce long-term cardiac and all-cause mortality in patients with HFrEF compared to sacubitril/valsartan monotherapy?
Cohort (n=244)
Does sacubitril/valsartan combined with dapagliflozin reduce long-term cardiac and all-cause mortality in patients with HFrEF compared to sacubitril/valsartan monotherapy?
The combination of sacubitril/valsartan and dapagliflozin significantly reduces long-term cardiac mortality compared to sacubitril/valsartan monotherapy in patients with HFrEF.
Answers are grounded in this paper and cite their sources.
May support lower cardiac mortality with ARNI-dapagliflozin in HFrEF; hypothesis-generating and requires RCTs before practice change.
The angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan and sodium-glucose cotransporter-2 (SGLT-2) inhibitor dapagliflozin have been shown to reduce rehospitalization and cardiac mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to compare the long-term cardiac and all-cause mortality of ARNI and dapagliflozin combination therapy against ARNI monotherapy in patients with HFrEF. This retrospective study involved 244 patients with HF with New York Heart Association (NYHA) class II–IV symptoms and ejection fraction ≤40%. The patients were divided into 2 groups: ARNI monotherapy and ARNI+dapagliflozin. Median follow-up was 2.5 (.16–3.72) years. One hundred and seventy-five (71.7%) patients were male, and the mean age was 65.9 (SD, 10.2) years. Long-term cardiac mortality rates were significantly lower in the ARNI+dapagliflozin group (7.4%) than in the ARNI monotherapy group (19.5%) ( P = .01). Dapagliflozin [Hazard Ratio (HR) [95% Confidence Interval (CI)] = .29 [.10–.77]; P = .014] and left ventricular ejection fraction (LVEF) [HR (95% CI) = .89 (.85–.93); P < .001] were found to be independent predictors of cardiac mortality. Our study showed a significant reduction in cardiac mortality with ARNI and dapagliflozin combination therapy compared with ARNI monotherapy.
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Karabulut et al. (2021) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=244). ARNI and dapagliflozin combination therapy vs. ARNI monotherapy was evaluated on Long-term cardiac mortality (HR 0.29, 95% CI 0.10-0.77, p=0.014). ARNI and dapagliflozin combination therapy significantly reduced long-term cardiac mortality compared with ARNI monotherapy (7.4% vs 19.5%; HR 0.29, 95% CI 0.10-0.77; P=0.014).
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