Prescription Pattern in Angiotensin Receptor Neprilysin Inhibitor is Associated with Heart Failure Events

Area of Science:

• Cardiology
• Pharmacology

Background:

• Angiotensin receptor neprilysin inhibition (ARNI) is proven superior to enalapril in reducing cardiovascular mortality and heart failure hospitalizations (HFH).
• The association between ARNI prescription patterns and heart failure outcomes remains underexplored.

Purpose of the Study:

• To investigate the impact of ARNI dose up-titration and prescription timing on heart failure outcomes.
• To identify predictors of cardiovascular death and HFH in patients receiving ARNI therapy.

Main Methods:

• Retrospective study of 153 patients treated with ARNI at a tertiary medical center.
• Analysis of dose up-titration and prescription timing (initial admission, within 3 months post-discharge, outpatient without prior HFH).
• Primary endpoint: composite of cardiovascular death and HFH; Kaplan-Meier and Cox regression analyses were performed.

Main Results:

• The primary endpoint occurred in 28.1% of patients over a mean follow-up of 287 days.
• Significant differences observed in baseline characteristics including VHD, VT, PCI, CABG, CKD, age, and diastolic blood pressure between patients with and without the primary endpoint.
• ARNI up-titration and prescription timing were significantly associated with primary endpoint-free survival (p=0.032 and p=0.001, respectively).
• Independent predictors for the primary endpoint included ARNI up-titration (HR: 0.41), non-hospital vs. hospital ARNI prescription (HR: 0.41), VHD (HR: 2.71), VT (HR: 3.09), and age (HR: 1.03).

Conclusions:

• ARNI prescription patterns, including dose titration and timing, are associated with heart failure events.
• Optimizing ARNI prescription strategies may improve cardiovascular outcomes in heart failure patients.