J Cardiovasc Pharmacol. 2023 Mar 31. doi: 10.1097/FJC.0000000000001421. Online ahead of print.
We performed a meta-analysis investigating the efficacy and adverse effects of sacubitril-valsartan in various types of heart failure including more recent studies and a larger sample size.We conducted an electronic search through Cochrane, Web of Science, PubMed, and Embase. Included studies were randomized control trials analyzing the efficacy of sacubitril-valsartan compared to an angiotensin converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB) in heart failure patients.Fourteen trials were included. Pooled estimates were analyzed using RevMan 5.4.1. The odds ratio (OR) of hospitalization from worsening heart failure compared sacubitril-valsartan to control was 0.70 (95% CI, 0.51-0.97; p = 0.03) in heart failure reduced ejection fraction (HFrEF) patients with a relative risk reduction (RRR) of 24.3% and absolute risk reduction (ARR) of 3.4%. In heart failure with midrange (HFmEF) and preserved ejection fraction (HFpEF) patients, the OR was 0.80 (95% CI, 0.71-0.90; p = 0.0001) with RRR of 14.5% and ARR of 3.3%. There was a significant reduction in cardiovascular deaths (OR, 0.79; 95% CI 0.70-0.89; p = <0.0001) and all-cause mortality (OR, 0.84; 95% CI 0.75-0.94; p = 0.002) in HFrEF patients, with no significant differences in HFmEF and HFpEF patients.Hospitalization rate was significantly reduced in sacubitril-valsartan patients across all analyzed cohorts. Sacubitril-valsartan significantly reduced the risk of all-cause mortality and cardiovascular death in HFrEF patients, but not in HFmEF/HFpEF patients. These findings support sacubitril-valsartan use in reducing hospitalization of HFmEF and HFpEF patient. More studies should be performed to further analyze the efficacy of sacubitril-valsartan in HFmEF/HFpEF patients.