Angiotensin-Neprilysin Inhibitor Therapy: A Retrospective Chart Study

Background: Guideline-directed medical therapy in patients with systolic heart failure (HF) has demonstrated improvement in morbidity and mortality rates. The FDA approved sacubitril/valsartan in 2015 to reduce the risk of cardiovascular death and hospitalization for HF. Objective: The purpose of this study was to evaluate the change in loop diuretic dose and the clinical outcomes of angiotensin receptor-neprilysin inhibitor (ARNI) therapy within a 90-day follow-up period. Methods: A retrospective chart review of 110 HF patients on concomitant ARNI and loop diuretic therapy at New York University Langone Health was conducted. The primary endpoint was a change in loop diuretic dose. Six secondary endpoints, including dose conversion from ACEi or ARB to ARNI therapy, were assessed. Results: Of the 110 HF patients, 72 did not receive diuretic dose adjustments, yet 40 (55.56%) experienced laboratory-dependent dehydration. Fifty-six percent of patients experienced an improvement in systolic blood pressure, and 52 percent experienced a decrease in diastolic blood pressure. Sixty percent of patients experienced an improvement in EF, with a median increase of 10.00% over a 90-day follow-up. A significant negative correlation between patients' age and absolute change in EF was identified (r= -0.28; p < 0.05), indicating that the increase in EF was stronger for younger patients. Eighteen hospitalizations occurred within a 90-day follow-up, with only 4 patients being admitted for heart failure exacerbation. Conclusion and Relevance: This study examines the real-world effects of ARNI therapy in patients with systolic heart failure. Optimization of HF medications, including ARNI therapy, remains an important factor for achieving the maximum benefits in heart failure management. ARNI therapy requires careful monitoring to ensure effective diuresis in symptomatic heart failure patients while avoiding adverse events. Future studies should address diuretic dose adjustment in conjunction with the administration of ARNI and sodium-glucose cotransporter-2 inhibitors.