Safety and effectiveness of angiotensin receptor-neprilysin inhibitors in patients with heart failure with preserved ejection fraction (ARNI-PRESERVED study)

Type of funding sources: None.

The goal of this study is to look at the safety and efficacy of ARNI (valsartan/sacubitril), a combination of angiotensin II receptor blocker and neprilysin inhibitor (ARNI), in patients with heart failure with preserved ejection fraction (HFpEF).

ARNI decreases the hazard of cardiovascular death and hospitalization in patients with chronic HFrEF (NYHA Class II–IV). Although there are several evidence based therapies for HFrEF, there is no effective therapy for HFpEF at the presently. In Paragon-HF trial, ARNI demonstrated a minimal evidence of additional improvements in patients with HFpEF

A retrospective research with a clinical population was carried out. A total of 154 HFpEF patients (87 females and 67 males) were treated with ARNI, which was subsequently titrated up to a maximum tolerable dose and monitored in an outpatient clinic. 56 patients were given ARNI while in the hospital for decompensated heart failure before being discharged.

Patients were categorized as New York Heart Association (NYHA) class III (71.4%) and NYHA class II (28.6%). Diabetes mellitus was identified in 52% of patients, while hypertension was found in 78%. Symptomatic clinical improvement was observed, with a substantial decrease in NYHA class down to NYHA class II (p=0.018). A considerable decrease in NYHA class resulted in symptomatic clinical improvement as well as the rales and peripheral oedema had resolved (p<0.001). The NT-pro-BNP levels were considerably lowered (p<0.001). The echocardiographic parameters for diastolic function (E/A, E/E’ ratios) improved. In individuals with HFpEF, ARNI resulted in significant clinical benefits (Table -1).

In individuals with HFpEF, sacubitril/valsartan, ARNI resulted in significant clinical benefits A randomized research is also required to see if it results in beneficial outcomes for a wider sample.