Monitoring angiotensin receptor-neprilysin inhibitor usage and clinical outcomes in heart failure patients: Real-world evidence from a tertiary care center in Thailand

This retrospective study investigated the real-world usage patterns, effectiveness, and safety of the angiotensin receptor–neprilysin inhibitor (ARNI) in patients with heart failure with reduced ejection fraction (HFrEF) at a tertiary care center in Thailand. A total of 249 patients who initiated ARNI between January 1, 2018, and June 30, 2022, were included. The average age was 61.3 ± 11.1 years, and 69.1% were male. The mean BMI was 25.7 ± 13.4 kg/m², and the average body weight was 66.4 ± 13.8 kg. The baseline left ventricular ejection fraction (LVEF) was 28.4% ± 8.7%. Most patients (57.4%) were administered ARNI at a dose of 100 mg/day. The average follow-up was 18.5 months, and the maximum tolerable dose was 179.0 ± 98.7 mg/day, with 12.0% attaining the target dose. No deaths were recorded; however, 8.8% of the patients were hospitalized for heart failure. LVEF improved significantly at 6, 12, 18, 24, and 30 months, with 67.2% achieving LVEF ≥40%. Discontinuation of ARNI occurred in 20.9%, primarily due to hyperkalemia (9.3%), hypotension (6.0%), and a decrease in renal function (5.2%). These findings confirm ARNI’s effectiveness in improving cardiac function in Thai HFrEF patients while emphasizing the need for close monitoring to manage adverse effects and optimizing dosing strategies.