Angiotension Receptor Neprylisin Inhibitor as New Paradigm in Managing Patients with Heart Failure with Reduced Ejection Fraction

Author : S. R. Wibawa, I. Y. Puspowardojo
Upload Date : 19-04-2018

Background: Heart failure (HF) is still a rapid growing public health issue, with a prevalence of over 30 million worldwide. Despite improvement in therapy, the morbidity and mortality rate in patients with HF has remained surprisingly high. Heart failure with reduced ejection fraction (HFrEF) despite having decreased prevalence among other types of HF, still showed the highest rate for morbidity and mortality. Natriuretic system modulation opens up a new paradigm in the management of patients with HFrEF, with Angiotensin Receptor Neprilysin Inhibitor (ARNI) showing great potential as one of the tools clinician can use to decrease morbidity and mortality rate of HFrEF.

Aims: This literature review aims to find information regarding the use of ARNI to reduce morbidity and mortality rate of HFrEF.

Methods: Medical journals search method using search engines which covers PubMed, Cochrane, Springer, Trip database, and Science Direct. Medical journal selections have been screened based on inclusion criteria in the form of articles Randomized Clinical Trial (RCT) or meta-analyzes of RCTs, studies in patients with heart failure. Exclusion criteria used include articles other than English, animal studies, opinion articles, and article with no abstract. Once inclusion and exclusion criteria has been used, single article was found as other studies are still ongoing their researches.

Result: In the only one article selected, the efficacy of ARNI in reducing morbidity and mortality in HFrEF is highly more superior to that of ACE inhibitor. ARNI reduces the risk of hospitalization for heart failure by 21 % (p < 0.001) and death from cardiovascular causes by 20% (p<0.001). This trial was stopped early because the boundary for an overwhelming benefit with ARNI was exceeded.

Conclusion: ARNI effectively improves morbidity and mortality on patients with HFrEF, however more studies are still required to ascertain this effect in different groups of patients.

KEYWORDS : Angiotension Receptor Neprylisin Inhibitor, Management, Heart Failure with Reduced Ejection Fraction

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