Angiotensin Receptor Neprilysin Inhibitor for Patients With Heart Failure and Reduced Ejection Fraction: Real-World Experience From Taiwan

Fu Chih Hsiao, Chun Li Wang, Po Cheng Chang, Yu Ying Lu, Chien Ying Huang, Pao Hsien Chu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

20 Scopus citations


Background: Angiotensin receptor neprilysin inhibitor (ARNI) was recommended by major guidelines as the frontline therapy for heart failure with reduced ejection fraction (HFrEF) since its clinical benefit was proved in the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF) trial. However, little is known about its safety and effectiveness in real-world practice, often with sicker and more fragile patients. In addition, East Asia population is underrepresented in PARADIGM-HF trial. Methods: We performed a retrospective analysis of patients who received ARNI in 3 medical institutes located in Northern Taiwan. Patients who received a prescription of at least 30 days of ARNI were enrolled. The date of first prescription was defined as the index date, and a period of 12 months preceding the index date was defined as the baseline period. Results: A total of 452 patients were identified (age: 61.9 ± 15.0, male: 79.4%). Compared to PARADIGM-HF populations, our patients had higher values of baseline serum creatinine (mean: 1.5 vs 1.1 mg/dL) and B-type natriuretic peptide (BNP; median: 554.5 vs 255 pg/mL). After 12 months, 41.6% of the patients received less than half of the standard dose. Overall, all-cause death, cardiovascular death, and heart failure readmission rate were 3.0%, 1.1%, and 6.9% in 12 months, respectively. In those who had both baseline and 12-month data, renal function did not change (1.7-1.8 mg/dL, P =.091), left ventricular ejection fraction improved (30.8%-36.8%, P <.001), BNP decreased (777.0-655.8 pg/mL, P =.032), and uric acid decreased (7.5-7.1 mg/dL, P =.009). Conclusion: In our study, patients with HFrEF had higher BNP and serum creatinine level at baseline and had received lower dose of ARNI than the PARADIGM-HF populations. Angiotensin receptor neprilysin inhibitor appeared to be safe as regard renal function and effective in real-world practice. Left ventricular reverse remodeling was observed 1 year after heart failure medication treatment, including ARNI.

Original languageEnglish
Pages (from-to)152-157
Number of pages6
JournalJournal of Cardiovascular Pharmacology and Therapeutics
Issue number2
StatePublished - 01 03 2020

Bibliographical note

Publisher Copyright:
© The Author(s) 2019.


  • ARNI
  • angiotensin receptor-neprilysin inhibitor
  • heart failure with reduced ejection fraction
  • real-world
  • sacubitril/valsartan


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