ARNI treatment reduced all-cause mortality by 26% (HR 0.74) in HFrEF patients over 6 years, but did not significantly reduce hospitalizations.
Does ARNI treatment reduce mortality and hospitalizations in HFrEF patients aged ≥40 years?
In a real-world cohort of HFrEF patients, ARNI use was associated with a significant reduction in all-cause mortality but not hospitalizations over 6 years of follow-up.
Absolute Event Rate: 0% vs 0%
Abstract Background Heart failure with reduced ejection fraction (HFrEF) is a chronic condition associated with high mortality, frequent hospitalizations, reduced quality of life, and significant healthcare costs. Angiotensin receptor-neprilysin inhibitors (ARNI) have shown efficacy in improving outcomes in HFrEF patients. However, only few studies were conducted using real-world data, and long-term associations with mortality and hospitalizations remain to be studied. Purpose To study the effectiveness of ARNI treatment in HFrEF patients in reducing mortality and hospitalizations over six-years of follow-up. Methods We conducted a historical cohort study, using data from Clalit Health Services, Israel’s largest healthcare provider. We included HFrEF patients aged≥40 years, followed from the date ARNI treatments were available in Israel (1/2017) until death, hospitalizations, or 5/2023. ARNI users (n=3,017) were matched 1:1 to non-users using nearest neighbor propensity score, based on sex, age, registry entry, diabetes, and medications. Sensitivity analyses included a whole cohort analysis with time dependent models; 1:1 exact matching based on sex, birth year, and registry entry date; and stratifying the analysis by ACEi/ARB history. Kaplan-Meier survival analyses and Cox proportional hazards models (with and without time varying covariates) were used to compare the risk for death or hospitalizations by ARNI treatment, yielding hazard ratios (HR) and 95% confidence intervals (CI). Results The cohort consisted of 79% men aged 72.4 years (SD=11.4). ARNI treatment was associated with a 26% reduction in mortality risk (HR:0.74, 95%CI:0.66–0.82). No significant reduction was observed in hospitalization rates (HR:0.95, 95% CI:0.85–1.02). Sensitivity analyses yielded similar results with HR for mortality ranging 0.62-0.87. Conclusion This real world data study in patients with HFrEF demonstrated risk reduction of all-cause mortality among ARNI treated individuals that is similar to those shown in clinical trials. Nevertheless, our study did not demonstrate any benefit of ARNI in preventing hospitalizations. Our sensitivity analyses provided similar results to the main analysis supporting the robustness of our findings.KM for All-Cause Mortality KM for All-Cause Hospitalizations
Erlich et al. (Sat,) reported a other. ARNI treatment reduced all-cause mortality by 26% (HR 0.74) in HFrEF patients over 6 years, but did not significantly reduce hospitalizations.