Sacubitril/Valsartan Versus Angiotensin-Converting Enzyme Inhibitor/Angiotensin Receptor Blocker Across the Ejection Fraction Spectrum: A Multistate Real-World Cohort - Takeaways - MDSpire
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Sacubitril/Valsartan Compared With ACE Inhibitors or Angiotensin Receptor Blockers Across Ejection Fraction Levels: A Real-World Multistate Cohort Study

  • By

  • MICHEL CHEDID EL HELOU

  • KARIM HOYEK

  • HARSH PATOLIA

  • MICHAEL HILL

  • ZIAD ZALAQUETT

  • HUNTER BLOCK-BEACH

  • ASHISH SARRAJU

  • AMANDA R. VEST

  • NANCY M. ALBERT

  • RANDALL C. STARLING

  • TREJEEVE MARTYN

  • October 10, 2026

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  • 1

    This retrospective cohort includes 25,333 adults with heart failure from more than 275 outpatient clinics and 22 hospitals across Ohio and Florida.

  • 2

    The primary outcome is all-cause death or first all-cause hospitalization over 2 years; 10,755 patients (42.5%) experience this outcome.

  • 3

    Sacubitril/valsartan (ARNI) use is associated with lower adjusted risk of death or hospitalization than ACEi/ARB use overall (HR, 0.87; 95% CI, 0.82–0.93).

  • 4

    Among patients with LVEF >40%, ARNI use is associated with lower risk than ACEi/ARB use (adjusted HR, 0.74; 95% CI, 0.66–0.83).

  • 5

    No significant treatment-by-LVEF interaction is observed (P = .166). The association at LVEF ≥60% is hypothesis-generating because ARNI use is uncommon, confidence intervals are wide, and confounding by indication limits interpretation.

Original Source(s)

Sacubitril/Valsartan Versus Angiotensin-Converting Enzyme Inhibitor/Angiotensin Receptor Blocker Across the Ejection Fraction Spectrum: A Multistate Real-World Cohort

  • by MICHEL CHEDID EL HELOU, KARIM HOYEK, HARSH PATOLIA, MICHAEL HILL, ZIAD ZALAQUETT, HUNTER BLOCK-BEACH, ASHISH SARRAJU, AMANDA R. VEST, NANCY M. ALBERT, RANDALL C. STARLING, TREJEEVE MARTYN

  • October 10, 2026

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