COMPARATIVE EFFECTIVENESS AND SAFETY OF ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITORS VERSUS ACEI/ARB THERAPY IN HEART FAILURE: A REAL-WORLD RETROSPECTIVE COHORT STUDY
Author(s)
Prasanna Kumar, M Pharm, PhD1, Kotian Prekshith Jaya, Pharm D2, Arshan Sudhir, Pharm D2, Mukund Prabhu, MBBS, MD (General Medicine), DM (Cardiology)3.
1Assistant Professor, Dept. of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India, 2Dept. of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Ed, Manipal, India, 3Dept. of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India, Manipal, India.
1Assistant Professor, Dept. of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India, 2Dept. of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Ed, Manipal, India, 3Dept. of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India, Manipal, India.
OBJECTIVES: To compare the real-world effectiveness and safety of angiotensin receptor-neprilysin inhibitor (ARNI) therapy with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy among patients with heart failure.
METHODS: A retrospective comparative cohort study was conducted at a tertiary-care teaching hospital in India. Adult patients with heart failure receiving ARNI or ACEI/ARB therapy between January 2022 and December 2023 were included. Missing data were handled using multiple imputation by chained equations. Baseline-adjusted linear regression was used to evaluate effectiveness outcomes (NT-proBNP and left ventricular ejection fraction [LVEF]), while logistic regression assessed safety outcomes. Hospital readmissions were evaluated using negative binomial regression and Kaplan-Meier survival analysis. Complete-case sensitivity analyses assessed the robustness of the findings.
RESULTS: A total of 516 patients were included (ARNI: n=289; ACEI/ARB: n=227). After baseline adjustment, ARNI therapy was associated with a significant improvement in log-transformed NT-proBNP compared with ACEI/ARB therapy (adjusted mean difference 0.318; 95% CI 0.044-0.592; p=0.023). ARNI therapy was also associated with significantly lower odds of hyperkalemia (OR 0.501; 95% CI 0.260-0.964; p=0.039). No significant differences were observed in LVEF improvement, worsening renal function, hyponatremia, hospital readmission rates, or time to first readmission. Complete-case sensitivity analysis showed attenuation of the NT-proBNP association (adjusted mean difference 0.225; 95% CI −0.122 to 0.572; p=0.204), whereas the reduction in hyperkalemia remained significant (OR 0.501; 95% CI 0.260-0.946; p=0.039).
CONCLUSIONS: In this real-world cohort, ARNI therapy demonstrated superior biomarker response and a lower risk of hyperkalemia compared with ACEI/ARB therapy, while hospital readmission outcomes were comparable. These findings support the effectiveness and safety of ARNI therapy in routine clinical practice while highlighting the need for prospective multicenter studies to confirm these observations.
METHODS: A retrospective comparative cohort study was conducted at a tertiary-care teaching hospital in India. Adult patients with heart failure receiving ARNI or ACEI/ARB therapy between January 2022 and December 2023 were included. Missing data were handled using multiple imputation by chained equations. Baseline-adjusted linear regression was used to evaluate effectiveness outcomes (NT-proBNP and left ventricular ejection fraction [LVEF]), while logistic regression assessed safety outcomes. Hospital readmissions were evaluated using negative binomial regression and Kaplan-Meier survival analysis. Complete-case sensitivity analyses assessed the robustness of the findings.
RESULTS: A total of 516 patients were included (ARNI: n=289; ACEI/ARB: n=227). After baseline adjustment, ARNI therapy was associated with a significant improvement in log-transformed NT-proBNP compared with ACEI/ARB therapy (adjusted mean difference 0.318; 95% CI 0.044-0.592; p=0.023). ARNI therapy was also associated with significantly lower odds of hyperkalemia (OR 0.501; 95% CI 0.260-0.964; p=0.039). No significant differences were observed in LVEF improvement, worsening renal function, hyponatremia, hospital readmission rates, or time to first readmission. Complete-case sensitivity analysis showed attenuation of the NT-proBNP association (adjusted mean difference 0.225; 95% CI −0.122 to 0.572; p=0.204), whereas the reduction in hyperkalemia remained significant (OR 0.501; 95% CI 0.260-0.946; p=0.039).
CONCLUSIONS: In this real-world cohort, ARNI therapy demonstrated superior biomarker response and a lower risk of hyperkalemia compared with ACEI/ARB therapy, while hospital readmission outcomes were comparable. These findings support the effectiveness and safety of ARNI therapy in routine clinical practice while highlighting the need for prospective multicenter studies to confirm these observations.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO6
Topic
Clinical Outcomes, Patient-Centered Research, Real World Data & Information Systems
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)