PMID- 38541798
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240330
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 13
IP  - 6
DP  - 2024 Mar 9
TI  - The Efficacy and Safety of Sacubitril/Valsartan Compared to Valsartan in Patients 
      with Heart Failure and Mildly Reduced and Preserved Ejection Fractions: A 
      Systematic Review and Meta-Analysis of Randomized Controlled Trials.
LID - 10.3390/jcm13061572 [doi]
LID - 1572
AB  - Background: Sacubitril/valsartan improves heart failure (HF) outcomes in patients 
      with heart failure with reduced ejection fraction (HFrEF). However, randomized 
      controlled trials (RCTs) in patients with heart failure and mildly reduced 
      ejection fraction (HFmrEF) and heart failure with preserved ejection fraction 
      (HFpEF) have shown inconsistent results. We conducted this meta-analysis to 
      comprehensively evaluate the efficacy and safety of sacubitril/valsartan compared 
      to valsartan within this specific patient population. Methods: We searched the 
      MEDLINE database and ClinicalTrials.gov and identified four RCTs that could be 
      included in our analysis, with 3375 patients in the sacubitril/valsartan group 
      and 3362 in the valsartan group. Results: Our study shows that, in patients with 
      HFmrEF and HFpEF, sacubitril/valsartan was superior to valsartan in some of the 
      key HF outcomes, such as the Kansas City Cardiomyopathy Questionnaire Clinical 
      Summary Score (KCCQ CSS), with a small but significant mean difference of 1.13 
      (95% confidence interval or CI of 0.15 to 2.11, p-value 0.024), an improvement in 
      the New York Heart Association (NYHA) class (odds ratio or OR of 1.32, 95% CI 
      1.11 to 1.58, p-value 0.002), and the composite outcome of hospitalizations for 
      HF and cardiovascular death, with a relative risk (RR) of 0.86 (95% CI 0.75 to 
      0.99, p-value 0.04). However, there was no additional benefit with 
      sacubitril/valsartan compared to valsartan for the outcomes of cardiovascular 
      death and all-cause mortality. In terms of side effects, sacubitril/valsartan was 
      associated with a higher risk of hypotension when compared to valsartan (OR 1.67, 
      95% CI 1.27 to 2.19, p-value < 0.0001), but did not show an increased risk of 
      hyperkalemia or worsening renal function. Conclusions: In individuals with HFmrEF 
      or HFpEF, sacubitril/valsartan can result in improvements in the HF outcomes of 
      the KCCQ CSS, the NYHA class, and the composite outcome of hospitalization for HF 
      and cardiovascular death when compared to valsartan. While there was a higher 
      risk of hypotension with sacubitril/valsartan compared to valsartan, there was no 
      corresponding increase in the risk of hyperkalemia or worsening renal function.
FAU - Kommu, Sharath
AU  - Kommu S
AD  - Department of Hospital Medicine, Marshfield Clinic Health System, Rice Lake, WI 
      54868, USA.
AD  - Department of Medicine, UW School of Public Health and Medicine, Madison, WI 
      53705, USA.
FAU - Berg, Richard L
AU  - Berg RL
AUID- ORCID: 0009-0001-3732-0716
AD  - Office of Research Computing and Analytics, Marshfield Clinic Research Institute, 
      Marshfield, WI 54449, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20240309
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC10971386
OTO - NOTNLM
OT  - ARNI
OT  - HFmrEF
OT  - HFpEF
OT  - angiotensin receptor-neprilysin inhibitor
OT  - heart failure
OT  - heart failure with mildly reduced ejection fraction
OT  - heart failure with preserved ejection fraction
OT  - sacubitril/valsartan
OT  - valsartan
COIS- The authors declare no conflicts of interest.
EDAT- 2024/03/28 06:45
MHDA- 2024/03/28 06:46
PMCR- 2024/03/09
CRDT- 2024/03/28 01:15
PHST- 2024/01/13 00:00 [received]
PHST- 2024/02/21 00:00 [revised]
PHST- 2024/02/29 00:00 [accepted]
PHST- 2024/03/28 06:46 [medline]
PHST- 2024/03/28 06:45 [pubmed]
PHST- 2024/03/28 01:15 [entrez]
PHST- 2024/03/09 00:00 [pmc-release]
AID - jcm13061572 [pii]
AID - jcm-13-01572 [pii]
AID - 10.3390/jcm13061572 [doi]
PST - epublish
SO  - J Clin Med. 2024 Mar 9;13(6):1572. doi: 10.3390/jcm13061572.