Efficacy and safety of sacubitril-valsartan in patients with heart failure: a systematic review and meta-analysis of randomized clinical trials

Abstract

Background: To investigate the efficacy and safety of sacubitril-valsartan in patients with heart failure, relevant randomized clinical trials (RCTs) were analyzed. Methods: We used Cochrane Library, PubMed web of science, CNKI, VIP, Medline, ISI Web of Science, CBMdisc, and Wanfang database to conduct a systematic literature research. A fixed-effects model was used to evaluate the standardized mean differences (SMDs) with 95% confidence intervals. We conducted sensitivity analysis and analyzed publication bias to comprehensively estimate the efficacy and safety of sacubitril-valsartan in patients with heart failure. Results: Among 132 retrieved studies, 5 relevant RCTs were included in the meta-analysis. The result showed that left ventricular ejection fraction (LVEF) was improved after sacubitril-valsartan in patients with heart failure, with an SMD (95% CI of 1.1 [1.01, 1.19] and P < .00001 fixed-effects model). Combined outcome indicators showed that, combined outcome indicators showed that, compared with control group, the left ventricular volume index (LAVI) (WMD = −2.18, 95% CI [−3.63, −0.74], P = .003), the E/e’ (WMD = −1.01, 95% CI [−1.89, −0.12], P = .03), the cardiovascular death (RR = 0.89, 95% CI [0.83, 0.96], P = .003], and the rehospitalization rate of heart failure (RR = 0.83, 95% CI [0.78, 0.88], P < .01) decreased more significantly, but it had no effect on renal function (WMD = 0.74, 95% CI [0.54, 1.01], P = .06). Conclusions: The present meta-analysis suggested that sacubitril-valsartan may improve the cardiac function of heart failure. Given the limited number of included studies, additional large sample-size RCTs are required to determine the long-term effect of cardiac function of sacubitril-valsartan in patients with heart failure.

Efficacy and safety profile of angiotensin receptor neprilysin inhibitors in the management of heart failure: a systematic review and meta-analysis of randomized controlled trials

“…We found that sacubitril-valsartan significantly reduces the adverse clinical outcomes such as all-cause mortality, cardiovascular mortality and hospitalizations for heart failure especially amongst patients with reduced ejection fraction. This was in line with the previous reviews reporting the efficacy of sacubitril-valsartan against mortality and hospitalization outcomes [15][16][17][18]. The distinguishing feature of our review is the comprehensive nature of the included studies (highest number of studies included across all these outcomes compared to previous reviews), subgroup analysis across multiple variables and additional analysis such as publication bias assessment and sensitivity analysis.…”

“…The European Society of Cardiology, American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America have recommended ARNIs as replacement for the ACE inhibitors in the management of heart failure especially those with reduced ejection fraction remaining symptomatic and belonging to the New York Heart Association (NYHA) classes II to IV [13,14]. However, only fewer systematic reviews are available on demonstrating the improvement in cardiac function after the ARNI therapy in patients with heart failure [15][16][17][18]. The available reviews have also included only a limited number of trials or fewer outcomes with respect to the efficacy and safety of ARNIs.…”

Sacubitril/Valsartan in Heart Failure Hospitalization: Two Pills a Day to Keep Hospitalizations Away?

“…left ventricular volume index (LAVI), the cardiovascular death (RR = 0.89, 95% CI = 0.83, 0.96, p = 0.003], and the rehospitalization rate of HF (RR = 0.83, 95% CI = 0.78, 0.88, p < 0.01) decreased more significantly compared to the control group[2]. The ability of sacubitril/valsartan to reduce hospitalizations is depicted by studies summarized in Table1.Sacubitril/Valsartan may improve cardiac function in HF.…”

“…In a systematic review and meta-analysis of randomized clinical trials, Lin et al described it as the “last battlefield” of cardiovascular diseases. The population’s prevalence rate of HF is 0.9% globally, and the prevalence rate increases significantly according to the epidemiological analysis [ 2 ]. The rate of re-admissions for HF patients also remains very high.…”

The Impact of Angiotensin Receptor–Neprilysin Inhibitors on Arrhythmias in Patients with Heart Failure: A Systematic Review and Meta-analysis

“…The effect of ARNIs on sudden cardiac death (SCD) has been widely reported, and while meta-analyses on outcomes such as primary total mortality and HF endpoints have been reported, little data exist regarding their effect on arrhythmia. 9 – 11 Given such a positive effect on reducing morbidity and mortality in HF patients, we aimed to emphasize the additional importance of reducing the burden of arrhythmia in this patient population using ARNI therapy.…”