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Should We Retain Half-Dose ARNIs in HFrEF? Lessons Learned from Reverse Remodeling using CORE-HF Real-World Data

AUTHORS

avatar Irnizarifka Irnizarifka ORCID 1 , 2 , * , avatar Irsyad Ristiansah ORCID 3 , avatar Habibie Arifianto ORCID 1 , 3 , avatar Trisulo Wasyanto 1

1 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia

2 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia. Tel: +62 81 22846594

3 HF Clinic Team of Universitas Sebelas Maret Hospital, Sukoharjo, Indonesia

How to Cite: Irnizarifka I, Ristiansah I, Arifianto H, Wasyanto T. Should We Retain Half-Dose ARNIs in HFrEF? Lessons Learned from Reverse Remodeling using CORE-HF Real-World Data. Int Cardio Res J. 2022;16(3):e129234.

ARTICLE INFORMATION

International Cardiovascular Research Journal: 16 (3); e129234
Published Online: September 30, 2022
Article Type: Research Article
Received: June 20, 2022
Accepted: October 01, 2022
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Abstract

Background: Heart failure (HF) is a progressive health problem with high mortality
and morbidity rates in both developed and developing countries. Patients with HF
who develop reverse remodeling during treatment have better outcomes and lower
mortality. Real-world data on the reverse remodeling effects of angiotensin-converting
enzyme inhibitors (ACEIs) and angiotensin receptor-neprilysin inhibitors (ARNIs) in
Indonesians are yet to be available.
Objectives: This study aimed to compare the reverse cardiac remodeling of patients
with heart failure with reduced ejection fraction (HFrEF) treated for six months with an
ARNI or ACEI based on the CORE-HF registry.
Methods: We conducted a non-experimental, sub-analysis study of the CORE-HF
database at the Heart Failure Clinic of Universitas Sebelas Maret Hospital from 2018 to
2021. One group had been treated with ARNIs, while the other was administered with
the optimal tolerated ACEI. A six-month follow-up was carried out to determine left
ventricle reverse remodeling (LVRR) and functional class alteration as endpoints.
Results: While 89.2% of those in the ACEI group could tolerate the maximum dose, only
one person in the ARNI group received the maximum dose, with the majority receiving
half the maximum dose (100 mg BID). After six months, LVRR occurred at a similar rate
in both groups (26.31% for ARNI and 26.15% for ACEI; P = 0.989). However, the New
York Heart Association functional class improved more in the ARNI group (mean 0.95
± 0.7 vs. 0.62 ± 0.86; P = 0.128).
Conclusions: Despite similar LVRR and functional capacity improvements, a slightly
better echocardiography improvement was observed in the ACEI arm. We postulate that
full intervention of the renin-angiotensin-aldosterone system should still be the main
goal, together with other guideline-directed medical therapies for HF. Hence, costeffective
full-dose of ACEi should be chosen for low- to middle-income countries whose
ARNI was not easily available yet due to several issues.

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References

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