Sacubitril/valsartan vs. angiotensin receptor inhibition in heart failure: a real-world study in Taiwan

Po Cheng Chang, Chun Li Wang, Fu Chih Hsiao, Ming Shien Wen, Chien Ying Huang, Chung Chuan Chou*, Pao Hsien Chu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

11 Scopus citations


Aims: This study aimed to compare the efficacy of angiotensin receptor–neprilysin inhibitor (ARNI) therapy with angiotensin receptor blocker (ARB) therapy for cardiovascular outcomes in patients with heart failure (HF) with reduced ejection fraction. Methods and results: Data were obtained from the Chang Gung Research Database. The cohort entry date of the ARB group was assigned as that of the ARNI group to avoid immortal time bias. Additionally, 1:1 propensity score matching based on age, sex, and baseline left ventricular ejection fraction was conducted. The expectation–maximization imputation method with inverse probability of treatment weighting was used to compare outcomes between the two groups. The primary outcome was a composite of cardiovascular death and hospitalization for worsening HF. Patients who received ARNI therapy had a significantly lower risk of the primary composite outcome occurring than patients who received ARBs (hazard ratio, 0.74; 95% confidence interval, 0.57–0.96). The reduction of hospitalization for worsening HF contributed most to the primary outcome benefits. In addition to the primary outcome, the ARNI group had a significantly lower risk of non-fatal myocardial infarction. The improvement of ejection fraction was not significantly different between the groups. The medication doses of ARNI were lower than in clinical trials. Conclusions: In patients with HF with reduced ejection fraction, sacubitril/valsartan was superior to ARB therapy in reducing the occurrence of the primary outcome endpoint of hospitalization for worsening HF and cardiovascular death.

Original languageEnglish
Pages (from-to)3003-3012
Number of pages10
JournalESC Heart Failure
Issue number5
StatePublished - 01 10 2020

Bibliographical note

Publisher Copyright:
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology


  • Angiotensin receptor blockers
  • Heart failure
  • Sacubitril/valsartan (LCZ696)


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