Abstract:Background and objectiveThe recent emergence of new molecules like angiotensin receptor-neprilysin inhibitor (ARNI) has highlighted the need for an update in heart failure (HF) management, as they have proven to yield better patient outcomes compared to the traditional angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) use. This study aimed to compare HF-related hospitalization and death in patients on either ACEI/ARBs or ARNI in a local setting.
MethodsThis two-arm intervention… Show more
“…The mean duration of this trial was 22 months The other 5 smaller comparative trials showed no superiority of SV over either enalapril/ramipril/valsartan in terms of either total or cardiovascular mortality. [10][11][12][13][14] Regarding hospitalization rate for heart failure, the data were not consistent. Two of these trials showed no differences between groups, while 3 did in favor of SV.…”
Section: Resultsmentioning
confidence: 88%
“…Since the publication of PARADIGM HF, 6 other comparative trials have been published that reports hard endpoints. [9][10][11][12][13][14] The largest is the PARADISE MI trial, which compared SV 97/103 mg twice a day to ramipril 5 mg twice a day in 5661 patients who had a recent myocardial infarction, reduced ejection fraction, and/or heart failure symptoms. 9 Unlike PARADIGM HF, there were no differences in total or cardiovascular mortality or rate of hospitalizations for heart failure.…”
Section: Resultsmentioning
confidence: 99%
“…To augment these contentions, several subsequent randomized trials comparing SV to either an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) have failed to corroborate some of the findings of PARADIGM HF, especially in regard to mortality, exercise tolerance, and quality of life scoring. [9][10][11][12][13][14][15][16][17][18] The purpose of this review was to identify and summarize those randomized trials, which compare SV to either ACEI or ARB in patients with HFrEF.…”
Background: The PARADIGM HF trial showed sacubitril/valsartan (SV) to be superior to enalapril in patients with reduced ejection fraction (HFrEF). Since its publication, several other randomized trials have compared SV to either an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) in HFrEF which showed conflicting results regarding mortality, hospitalizations, and quality of life scoring. Objective: To review randomized comparative trials of SV to either ACEI or ARB in patients with HFrEF. Methods: PubMed and Embase databases were used to identify randomized comparative trials. The text terms sacubitril, angiotensin neprilysin, and LCZ696 were used for both searches. Meta-analysis, retrospective, adhoc, and cohort studies were excluded. Results: 1476 and 3983 citations were reviewed on PubMed and Embase, respectively. Of these, 11 randomized comparative trials to either ACEI or ARB were included for analysis. The mortality/quality of life benefits of SV over enalapril in the PARADIGM HF were not corroborated in any of the other trials. The effect of hospitalizations for heart failure was inconsistent among trials. Exercise tolerance was not improved with SV versus enalapril. Conclusion: The results of the PARADIGM HF trial have largely not been confirmed in subsequent randomized comparative trials.
“…The mean duration of this trial was 22 months The other 5 smaller comparative trials showed no superiority of SV over either enalapril/ramipril/valsartan in terms of either total or cardiovascular mortality. [10][11][12][13][14] Regarding hospitalization rate for heart failure, the data were not consistent. Two of these trials showed no differences between groups, while 3 did in favor of SV.…”
Section: Resultsmentioning
confidence: 88%
“…Since the publication of PARADIGM HF, 6 other comparative trials have been published that reports hard endpoints. [9][10][11][12][13][14] The largest is the PARADISE MI trial, which compared SV 97/103 mg twice a day to ramipril 5 mg twice a day in 5661 patients who had a recent myocardial infarction, reduced ejection fraction, and/or heart failure symptoms. 9 Unlike PARADIGM HF, there were no differences in total or cardiovascular mortality or rate of hospitalizations for heart failure.…”
Section: Resultsmentioning
confidence: 99%
“…To augment these contentions, several subsequent randomized trials comparing SV to either an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) have failed to corroborate some of the findings of PARADIGM HF, especially in regard to mortality, exercise tolerance, and quality of life scoring. [9][10][11][12][13][14][15][16][17][18] The purpose of this review was to identify and summarize those randomized trials, which compare SV to either ACEI or ARB in patients with HFrEF.…”
Background: The PARADIGM HF trial showed sacubitril/valsartan (SV) to be superior to enalapril in patients with reduced ejection fraction (HFrEF). Since its publication, several other randomized trials have compared SV to either an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) in HFrEF which showed conflicting results regarding mortality, hospitalizations, and quality of life scoring. Objective: To review randomized comparative trials of SV to either ACEI or ARB in patients with HFrEF. Methods: PubMed and Embase databases were used to identify randomized comparative trials. The text terms sacubitril, angiotensin neprilysin, and LCZ696 were used for both searches. Meta-analysis, retrospective, adhoc, and cohort studies were excluded. Results: 1476 and 3983 citations were reviewed on PubMed and Embase, respectively. Of these, 11 randomized comparative trials to either ACEI or ARB were included for analysis. The mortality/quality of life benefits of SV over enalapril in the PARADIGM HF were not corroborated in any of the other trials. The effect of hospitalizations for heart failure was inconsistent among trials. Exercise tolerance was not improved with SV versus enalapril. Conclusion: The results of the PARADIGM HF trial have largely not been confirmed in subsequent randomized comparative trials.
Several guidelines have recommended the use of angiotensin receptor neprilysin inhibitors (ARNIs) as replacement for angiotensin-converting enzyme inhibitors in the management of heart failure. Till date, there are no reviews done that comprehensively cover different aspects of efficacy and safety parameters. Hence, we have performed a comprehensive systematic review and meta-analysis on role of ARNIs for the management of heart failure patients. Searches were done in Embase, Scopus, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, PubMed Central, Cochrane Library, MEDLINE, Google Scholar, ScienceDirect and Clinicaltrials.gov until June 2022. Risk of bias assessment was done with Cochrane’s risk of bias tool. Meta-analysis was carried out using random-effects model. Pooled standardized mean difference (SMD)/mean difference (MD) and/or risk ratio (RR) with 95% confidence intervals (CIs) was reported. In total, we analysed 34 studies, with almost all of them had a high risk of bias. Pooled RR was 0.88 (95% CI: 0.82–0.95) for all-cause mortality, 0.84 (95% CI: 0.77–0.92) for cardiovascular mortality and 0.78 (95% CI: 0.70–0.87) for hospitalization. Pooled MD was 3.74 (95% CI: 1.93–5.55) for left ventricular ejection fraction, −2.16 (95% CI: −3.58 to −0.74) for left atrial volume index, −3.80 (95% CI: −6.60 to −1.00) for left ventricular end-diastolic dimension and −1.16 (95% CI: −1.98 to −0.35) for E/E′ ratio. Regarding adverse events, pooled RR was 1.55 (95% CI: 1.31–1.85) for symptomatic hypotension, 0.93 (95% CI: 0.78–1.11) for worsening renal function, 1.09 (95% CI: 0.94–1.26) for hyperkalaemia and 1.29 (95% CI: 0.67–2.50) for angioedema. ARNIs had beneficial efficacy and safety profile on the management of heart failure especially patients with reduced ejection fraction.
The objective of this meta-analysis was to compare outcomes between sacubitril/valsartan and enalapril in patients with heart failure. We performed this meta-analysis according to the guidelines reported in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two independent authors systematically searched online databases including PubMed, Cochrane Library, and Web of Science from inception till September 15, 2023. Outcomes assessed in this meta-analysis included all-cause mortality, cardiovascular mortality, and cardiovascular-related hospitalization. A total of nine studies were included in this meta-analysis. Pooled analysis showed that the risk of all-cause mortality was higher in patients receiving enalapril compared to patients receiving sacubitril/valsartan (risk ratio [RR]: 0.57; 95% CI: 0.31 to 1.04). Risk of cardiovascular mortality was significantly higher in the enalapril group compared to the sacubitril/valsartan group (RR: 0.75; 95% CI: 0.62 to 0.91). The risk of cardiovascular hospitalization was significantly higher in the enalapril group compared to the sacubitril/valsartan group (RR: 0.76; 95% CI: 0.66 to 0.86). In conclusion, our meta-analysis of nine studies underscores the superior clinical performance of sacubitril/valsartan compared to enalapril in managing patients with heart failure.
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