Patients with heart failure with reduced ejection fraction (HFrEF) discharged with angiotensin-receptor nardilysin inhibitors (ARNIs) like sacubitril/valsartan have a slightly higher survival rate compared with patients discharged on angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), according to study results presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13 to 15, 2021.

Researchers sought to estimate the association between discharge on ARNIs vs ACEi/ARB and patient outcomes by age. A 2-state absorbing Markov chain model with a 1-month cycle was used to simulate the 5-year survival rate for patients discharged on ARNIs or angiotensin inhibitors. Analyses accounted for risk for death and readmission (estimated from published PARADIGM-HF and PIONEER-HF trial results), as well as risk for drug switching, drug discontinuation, and in-hospital mortality (estimated from Medicare claims data).

Compared with patients discharged on angiotensin inhibitors, patients discharged on ARNIs had a higher 5-year survival rate across all age groups. After accounting for drug switching and discontinuation, the absolute and relative benefit of ARNIs over angiotensin inhibition was similar across age groups. To prevent 1 death over 5 years, the number needed to treat with ARNIs ranged from 56-63.

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The investigators suggested that a small but significant survival benefit exists for patients discharged on ARNIs vs ACEi/ARB. Future studies are necessary to find if additional heterogeneity of treatment effect is present in subgroups of high-risk, older patients.


Zipkin R, Barnes JA, Tosteson A, Gaziano TA, Gilstrap L. Discharge on sacubitril/valsartan vs ACEi/ARB in older patients with HFrEF: a decision analysis approach. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Poster 1700.