Impact of Angiotensin Receptor-Neprilysin Inhibitors on Patients With Acute Heart Failure Syndrome

TL;DR

This study shows that early use of ARNI therapy in acute heart failure patients with low ejection fraction reduces hospital stays and improves survival.

Contribution

The study evaluates the real-world impact of early ARNI therapy on in-hospital outcomes in AHFS patients with reduced LVEF.

Findings

Patients receiving ARNI had shorter hospital stays, with 75% discharged by day 12.75 compared to day 21.5 in the non-ARNI group.

ARNI therapy was associated with lower in-hospital mortality (2 deaths vs. 8 in the control group).

NT-ProBNP levels were significantly reduced over time in the ARNI group.

Abstract

Introduction

Sacubitril-valsartan has shown significant efficacy in improving outcomes for certain patient populations with acute heart failure syndrome (AHFS). This study aimed to evaluate the impact of early initiation of this angiotensin receptor-neprilysin inhibitor (ARNI) therapy on in-hospital outcomes in patients enrolled in the MALEOS registry for AHFS.

Objective

This study aims to assess the impact of ARNI therapy on hospitalization duration and mortality in patients with AHFS and a left ventricular ejection fraction (LVEF) below 40% at a healthcare institution in Cali, Colombia, between 2020 and 2022.

Materials and methods

A retrospective analysis was conducted using the MALEOS registry database to identify patients with AHFS and an LVEF < 40% between January 2020 and December 2022. Patients were stratified based on whether they received ARNI therapy. Mortality and length of hospitalization were assessed using multivariate Cox regression analysis and Kaplan-Meier survival curves.

Results

One hundred and seventy-seven patients were included in this study, of whom more than 90% were Hispanic from Colombia, and 40.2% were women. In the ARNI group, 75% of patients were discharged before 12.75 days, whereas in the non-ARNI group, 75% were discharged by day 21.5. N-terminal pro-B-type natriuretic peptide (NT-ProBNP) was significantly reduced over time in the ARNI group, and mortality was lower in this group, with two fatal outcomes versus eight in the control group (Log-rank: 0.18).

Conclusions

Early initiation of ARNI therapy in patients with AHFS and reduced LVEF has significantly decreased NT-proBNP levels over time, reduced hospital stay, and improved in-hospital mortality compared to standard care. However, larger randomized controlled trials are needed to confirm these findings and assess long-term outcomes.

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