Comparative Outcomes in Patients with Heart Failure with Reduced Ejection Fraction Treated with ACEIs/ ARBs Versus Sacubitril/Valsartan

Abstract

Background: Millions of people worldwide are affected by the very serious condition of heart failure with reduced ejection fraction (HFrEF). Both ACEI/ARB and Sacubitril/Valsartan are important treatments, even though we lack many real-world comparisons. Objective: the aim of the study is to identify the differences in outcomes observed in patients with HFrEF taking Sacubitril/Valsartan versus ACEI/ARB treatment. Methodology: An observational cohort study was conducted with 114 patients with HFrEF (LVEF ≤40%) and categorized into Group A (treated with ACEI/ARB) and Group B (treated with Sacubitril/Valsartan).  The study timeline was July 2023 and September 2024 at Ibrahim Cardiac Hospital & Research Institute. Relevant measurements (EF, SBP, HR, NT-proBNP, eGFR, potassium, NYHA class, symptoms, and adverse events) were recorded both before and after treatment. The statistical analysis employed SPSS for t-tests, chi-square tests, and odds ratios (only the results with p<0.05 were considered significant). Results: The mean baseline EF was lower for Group B (33.69%) than for Group A (36.67%), and this difference was significant (p=0.017). Following the treatment course, there was no real difference in EF improvement between the groups (Group A: 53.3%, Group B: 58.0%, p=0.473). The SBP was lower in Group B (115.6 mmHg) than in Group A (125.0 mmHg), and this difference was statistically significant (p=0.023). Group A had an 87.5% increase in NYHA Class I, higher than Group B’s 67.8% (p=0.056). Similar adverse effects were noted in patients (hyperkalemia, hypotension, renal impairment). Mortality (4.2% for group A and 2.2% for group B) and rehospitalization (4.2% for group A and 1.1% for group B) were not significantly different (p>0.05). There were no major differences in symptom relief for dyspnea, orthopnea, or PND (p>0.6). Conclusion: Sacubitril/Valsartan and Enalapril were found to be effective in treating HFrEF and gave similar safety and outcome results, though Sacubitril/Valsartan did a better job of controlling the heart’s blood flow.