Angiotensin-neprilysin inhibition in acute decompensated heart failure: A meta-analysis of randomized controlled trials

Hosam I. Taha; Abdalhakim Shubietah; Bashar M. Al Zoubi; Mohamed S. Elgendy; Hazem Reyad Mansour; Anas Abdulkader; Abdelrahman M. Ghazal; Noura Shamis; Mohamed Abuelazm; Mustafa Turkmani; Robert J. Mentz

doi:10.1080/14796678.2025.2535218

Angiotensin-neprilysin inhibition in acute decompensated heart failure: A meta-analysis of randomized controlled trials

Hosam I. Taha
, Abdalhakim Shubietah
, Bashar M. Al Zoubi
, Mohamed S. Elgendy
, Hazem Reyad Mansour
, Anas Abdulkader
, Abdelrahman M. Ghazal
, Noura Shamis
, Mohamed Abuelazm
, Mustafa Turkmani
, Robert J. Mentz

Advocate Health - Midwest

Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt.
Faculty of Medicine, The Hashemite University, Zarqa, Jordan.
College of Medicine, AlMaarefa University, Riyadh, Saudi Arabia.
Faculty of Medicine, Michigan State University, East Lansing, Michigan, USA.
Division of Cardiology and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.

Research output: Contribution to journal › Article

Abstract

Background: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF.

Methods: Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used.

Results: Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; p < 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; p = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; p < 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; p = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; p = 0.024).

Conclusion: initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk.

Original language	American English
Journal	Future Cardiology
DOIs	https://doi.org/10.1080/14796678.2025.2535218
Status	Published - Jul 21 2025

Access to Document

10.1080/14796678.2025.2535218License: Unspecified

http://institutionalrepository.aah.org/advocategme/1344

Cite this

@article{ae60e969bd784dc198b291645c4ea73e,

title = "Angiotensin-neprilysin inhibition in acute decompensated heart failure: A meta-analysis of randomized controlled trials",

abstract = "Background: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF. Methods: Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95\% confidence intervals (CI) were used. Results: Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95\% CI: 0.57-0.88; p < 0.01), HF rehospitalization (RR: 0.73; 95\% CI: 0.57-0.93; p = 0.01), worsening renal function (RR: 0.80; 95\% CI: 0.64-1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95\% CI: -0.34 to -0.14; p < 0.0001) and 8 weeks (SMD: -0.21; 95\% CI: -0.31 to -0.10; p = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95\% CI: 1.04-1.71; p = 0.024). Conclusion: initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk.",

author = "Taha, \{Hosam I.\} and Abdalhakim Shubietah and Zoubi, \{Bashar M. Al\} and Elgendy, \{Mohamed S.\} and Mansour, \{Hazem Reyad\} and Anas Abdulkader and Ghazal, \{Abdelrahman M.\} and Noura Shamis and Mohamed Abuelazm and Mustafa Turkmani and Mentz, \{Robert J.\}",

year = "2025",

month = jul,

day = "21",

doi = "10.1080/14796678.2025.2535218",

language = "American English",

journal = "Future Cardiology",

}

TY - JOUR

T1 - Angiotensin-neprilysin inhibition in acute decompensated heart failure: A meta-analysis of randomized controlled trials

AU - Taha, Hosam I.

AU - Shubietah, Abdalhakim

AU - Zoubi, Bashar M. Al

AU - Elgendy, Mohamed S.

AU - Mansour, Hazem Reyad

AU - Abdulkader, Anas

AU - Ghazal, Abdelrahman M.

AU - Shamis, Noura

AU - Abuelazm, Mohamed

AU - Turkmani, Mustafa

AU - Mentz, Robert J.

PY - 2025/7/21

Y1 - 2025/7/21

N2 - Background: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF. Methods: Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used. Results: Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; p < 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; p = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; p < 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; p = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; p = 0.024). Conclusion: initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk.

AB - Background: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF. Methods: Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used. Results: Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; p < 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; p = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; p < 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; p = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; p = 0.024). Conclusion: initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk.

U2 - 10.1080/14796678.2025.2535218

DO - 10.1080/14796678.2025.2535218

M3 - Article

C2 - 40689605

JO - Future Cardiology

JF - Future Cardiology

ER -