# Sacubitril/valsartan biedt geen voordeel boven ARB bij acute hartfalen met HFpEF of HFmrEF

*geplaatst 2026-10-20 · Hartfalen · Annals of medicine · doi 10.1080/07853890.2026.2743934 · https://hartvaat.nl/2026/12/01/sacubitril-valsartan-biedt-geen-voordeel-boven-arb-bij-acute-hartfalen-met-hfpef/*

In een retrospectieve cohortstudie van 9.107 patiënten met acuut hartfalen en een behouden of licht verminderde ejectiefractie (HFpEF/HFmrEF) werd de effectiviteit van in-hospitaal gestarte sacubitril/valsartan vergeleken met ARB-therapie. Na correctie voor confounders was er geen significant verschil in het samengestelde eindpunt van hartfalenheropname of cardiovasculaire dood (HR 0,97; 95% CI 0,79-1,20), ongeacht de nierfunctie. Deze real-world bevindingen suggereren dat ARNI niet superieur is aan standaard ARB-therapie in deze populatie, wat klinische besluitvorming rondom vroege start van deze medicatie ondersteunt.

## English: Clinical outcomes of sacubitril/valsartan in patients with mildly reduced or preserved ejection fraction and acute heart failure: a multi-institutional study.

A propensity-weighted cohort study of 9,107 patients hospitalized for acute heart failure with preserved or mildly reduced ejection fraction compared in-hospital initiation of sacubitril/valsartan with ARB therapy. The ARNI group showed no significant reduction in the composite of heart failure rehospitalization or cardiovascular death compared with ARBs (HR 0.97; 95% CI 0.79–1.20), with consistent results across all stages of chronic kidney disease. These real-world findings indicate that early sacubitril/valsartan initiation does not outperform standard ARB therapy in this population, supporting cautious interpretation of its routine use in acute HFpEF/HFmrEF.

## Abstract (original, from the publication)

BACKGROUND: The long-term real-world effectiveness and safety of in-hospital initiation of sacubitril/valsartan in patients hospitalized for acute heart failure (HF) with mildly reduced or preserved left ventricular ejection fraction (HFmrEF or HFpEF) remain uncertain, particularly among patients with advanced chronic kidney disease or dialysis, who are often underrepresented in randomized trials. PATIENTS/MATERIALS AND METHODS: We identified 9,107 patients with HFmrEF or HFpEF hospitalized for acute HF from the Chang Gung Research Database between January 1, 2016, and June 30, 2023. Propensity score weighting with overlap weights was applied to balance baseline characteristics between treatment groups. Risks of fatal and nonfatal outcomes were analyzed using Cox proportional hazards and Fine-Gray subdistribution hazard models, respectively. RESULTS: After overlap weighting, the incidence rates of the composite endpoint of HF rehospitalization and cardiovascular (CV) death were 39.7 and 40.3 per 100 person-years in the angiotensin receptor neprilysin inhibitor (ARNI) and angiotensin receptor blocker (ARB) groups, respectively (Hazard ratio, 0.97; 95% confidence interval, 0.79-1.20). In analyses stratified by chronic kidney disease stage, the association between treatment group and the primary endpoint was consistent among patients with eGFR ≥60, 30-59, <30 mL/min/1.73 m2, or dialysis. CONCLUSIONS: In this multi-institutional real-world cohort of patients hospitalized for acute HF with left ventricular ejection fraction (LVEF) >40%, in-hospital initiation of sacubitril/valsartan was not associated with lower risks of HF rehospitalization or CV death compared with ARB therapy, despite greater NT-proBNP reduction in a biomarker subcohort. Limited sample size precludes definitive conclusions regarding therapeutic equivalence.

Auteurs: Birdie Huang, Chun-Chi Chen, Ming-Lung Tsai, Ming-Jer Hsieh, Chieh-Yu Chang, Shao-Wei Chen, Tien-Hsing Chen, Pao-Hsien Chu, I-Chang Hsieh, Ming-Shien Wen, Dong-Yi Chen

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Bron: Annals of medicine, https://doi.org/10.1080/07853890.2026.2743934. Bijgewerkt 2026-10-14T00:53:37Z. 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.