The Efficacy of Sacubitril/Valsartan (ARNI) in Decreasing Mortality Among Heart Failure Patients: A Systematic Review and Meta-analysis

Introduction: Chronic heart failure (CHF) remains a leading cause of global morbidity and mortality, frequently resulting in hospitalizations and diminished quality of life. Sacubitril/Valsartan, the first angiotensin receptor-neprilysin inhibitor (ARNI) approved by the FDA, has shown promising effects in reducing mortality and improving clinical outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of Sacubitril/Valsartan compared with conventional therapies in patients with CHF. Methods: A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched up to April 18, 2024, using predefined terms. Eligible studies included randomized controlled trials comparing Sacubitril/Valsartan with standard therapies in adult CHF patients. Data extraction was performed independently by multiple reviewers, and study quality was assessed using the JBI checklist. Meta-analyses were conducted to estimate pooled outcomes. Results: Ten randomized controlled trials, including 15,650 patients, were analyzed. The mean age across studies was 68.4 years, with males comprising 59.4% of the Sacubitril/Valsartan group and 63.3% of the control group. Sacubitril/Valsartan significantly reduced NT-proBNP levels (SMD = -0.30, 95% CI: -0.58 to -0.03; p = 0.03) and disease-related events (OR = 0.82, 95% CI: 0.76-0.89; p < 0.00001). Hypotension was the most frequently reported adverse event (OR = 1.57, 95% CI: 1.28-1.93; p < 0.0001), whereas hyperkalemia and renal dysfunction did not differ significantly from control groups. Discussion: The findings indicate that Sacubitril/Valsartan improves outcomes in patients with CHF and exhibits an acceptable safety profile, although clinicians should monitor for hypotension. Conclusion: Sacubitril/Valsartan represents an effective therapeutic option for CHF, providing significant benefits in reducing mortality and morbidity compared with standard therapy.