# Schakelen naar ARNI verlaagt risico op nieuw atriumfibrilleren bij HFrEF

*geplaatst 2026-09-23 · Nierziekte · European heart journal. Cardiovascular pharmacotherapy · doi 10.1093/ehjcvp/pvag074 · https://hartvaat.nl/2026/09/15/schakelen-naar-arni-verlaagt-risico-op-nieuw-atriumfibrilleren-bij-hfref/*

Een landelijke cohortstudie onderzocht bij 39.061 patiënten met HFrEF zonder voorgeschiedenis van atriumfibrilleren (AF) het schakelen van RAS-remming naar ARNI het risico op nieuw AF. Na propensity score-matching vertoonde de ARNI-groep een lagere incidentie van nieuw AF (10,73 vs 12,15 per 100 persoonjaren; HR 0,89; 95% CI 0,81-0,98; p=0,021) en een gereduceerd samengesteld eindpunt. Hoewel observatieonderzoek geen causaal verband kan vaststellen, ondersteunt het de klinische overweging om bij HFrEF-patiënten zonder AF te schakelen naar ARNI voor mogelijk extra bescherming tegen het ontstaan van ritmestoornissen.

## English: Switching to Angiotensin Receptor-Neprilysin Inhibitor and Reduced Risk of New-Onset Atrial Fibrillation in Heart Failure with Reduced Ejection Fraction: A Nationwide Propensity Score-Matched Study.

A nationwide propensity-matched cohort study evaluated 39,061 HFrEF patients without prior atrial fibrillation (AF) to assess whether switching from traditional RAS blockade to an angiotensin receptor-neprilysin inhibitor (ARNI) reduces the risk of new-onset AF. The ARNI group showed a significantly lower incidence of new-onset AF (10.73 vs 12.15 per 100 person-years; HR 0.89; 95% CI 0.81-0.98; p=0.021) and a reduced composite endpoint of AF, ischaemic stroke, or all-cause mortality. While observational data cannot establish causality, these findings support considering ARNI therapy in AF-naïve HFrEF patients to potentially lower the risk of developing arrhythmias.

## Abstract (original, from the publication)

AIMS: We investigated whether switching from traditional renin-angiotensin system (RAS) blockade to angiotensin receptor-neprilysin inhibitor (ARNI) is associated with a lower risk of new-onset atrial fibrillation (AF) than continuing RAS blockade in patients with heart failure with reduced ejection fraction (HFrEF) without prior AF. METHODS AND RESULTS: Using data from the Korean National Health Insurance Service (2017-2021), we identified 39,061 patients with HFrEF without prior AF who received either ARNI (n = 12,263) or traditional RAS blockade (n = 26,798). After 1:1 propensity score matching, 9,030 patients were included in each group. The primary outcome was new-onset AF within 1 year. In the propensity score-matched cohort, new-onset AF incidence was lower in the ARNI group (10.73 vs. 12.15 per 100 person-years; hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.81-0.98; P = 0.021). The composite outcome (new-onset AF, ischaemic stroke, or all-cause death) was also reduced (HR 0.85; 95% CI 0.79-0.92; P < 0.001). In competing risk analysis, ARNI was associated with a lower subdistribution hazard of new-onset AF (sHR 0.73; 95% CI 0.58-0.91; P = 0.005). In the unmatched cohort, the HR was 0.85 (95% CI 0.75-0.96) in an exploratory model including age, sex, hypertension, chronic kidney disease, prior ischaemic stroke, socioeconomic status, residential region, and beta-blocker use, and 0.94 (95% CI 0.87-1.02) after adjustment for all measured baseline covariates. CONCLUSION: In this large nationwide cohort of AF-naïve patients with HFrEF, switching to ARNI was associated with a lower risk of short-term new-onset AF than continuing traditional RAS blockade. As this was a retrospective study, further prospective studies are needed to confirm these findings.

Auteurs: Young Jun Park, Dong-Hyuk Cho, Jimi Choi, Jong-Chan Youn, Mi-Na Kim, Chan Joo Lee, Jung-Woo Son, Byung-Su Yoo

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Bron: European heart journal. Cardiovascular pharmacotherapy, https://doi.org/10.1093/ehjcvp/pvag074. Bijgewerkt 2026-09-16T01:31:11Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.