ARNI like sacubitril-valsartan proves strong for chronic HFrEF management. Questions linger on starting it after acute decompensated heart failure stabilizes. This meta-analysis published in the Future Cardiology compares ARNI to ACEIs or ARBs for efficacy and safety in that window.
Methods Pool Latest RCT Evidence
Researchers searched PubMed, Scopus, Web of Science, Embase, and CENTRAL through November 2024 for RCTs. They included three trials with 1,741 patients post-ADHF. Risk ratios and standardized mean differences with 95% CIs measured outcomes like rehospitalization, mortality, renal function, and NT-proBNP levels.
Results Favor ARNI on Key Endpoints
ARNI lowered composite HF rehospitalization or all-cause mortality (RR 0.71, 95% CI 0.57-0.88, p<0.01). HF rehospitalization dropped (RR 0.73, 95% CI 0.57-0.93, p=0.01). Worsening renal function improved (RR 0.80, 95% CI 0.64-1.00, p=0.048). NT-proBNP fell at 4 weeks (SMD -0.24, 95% CI -0.34 to -0.14, p<0.0001) and 8 weeks (SMD -0.21, 95% CI -0.31 to -0.10, p=0.0001). Symptomatic hypotension rose (RR 1.33, 95% CI 1.04-1.71, p=0.024).
Conclusions Guide Post-ADHF Therapy Shift
ARNI initiation after ADHF stabilization beats ACEIs/ARBs for HF events, renal protection, and biomarkers despite hypotension risk. These findings support earlier ARNI use in stabilized HFrEF patients.