Combined Effects of ARNI & SGLT2 2 Inhibitors in Diabetic Patients with Heart Failure with Reduced Ejection Fraction

Syeda Kinza Bukhari; Javed Ahmad Khan; Bushra; Irfan Najam Sheen; Sidra Batool; Ayaz Ahmed

doi:10.70749/ijbr.v3i4.1025

Authors

Syeda Kinza Bukhari Department of Medicine Combined Military Hospital (CMH), Multan, Pakistan
Javed Ahmad Khan Department of Medicine Combined Military Hospital (CMH), Multan, Pakistan
Bushra Department of Medicine Combined Military Hospital (CMH), Multan, Pakistan
Irfan Najam Sheen Department of Medicine Combined Military Hospital (CMH), Multan, Pakistan
Sidra Batool Department of Medicine Combined Military Hospital (CMH), Multan, Pakistan
Ayaz Ahmed Department of Cardiology, Combined Military Hospital (CMH), Multan, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v3i4.1025

Keywords:

Heart Failure With Reduced Ejection Fraction, SGLT2 Inhibitors, Angiotensin Receptor-Neprilysin Inhibitors, Diabetes Mellitus

Abstract

Objective: To compare the efficacy of SGLT2i+ARNI and SGLT2i+ARB combination therapy in reducing heart failure hospitalization rates among diabetic patients with heart failure with reduced ejection fraction. Study Design: Randomized controlled trial. Duration and Place of Study: The study was conducted from May 2024 to November 2024 at the Medicine Department of CMH Multan. Methodology: 610 diabetic patients with heart failure with reduced ejection fraction (LVEF ≤40%) were randomly divided into two groups of 305 each. Group A received empagliflozin + sacubitril/valsartan while Group B received empagliflozin + valsartan. Patients were followed for six months with monthly clinical assessments. The primary outcome was heart failure hospitalization. Results: The SGLT2i+ARNI group showed significantly lower HF hospitalization rates (17%) compared to the SGLT2i+ARB group (23.9%, p=0.035). Subgroup analysis revealed particular benefits in patients aged 61-80 years (p=0.031), males (p=0.033), and NYHA class II patients. Logistic regression identified age (OR=0.973, p=0.034) and NYHA class (p<0.001) as significant predictors of hospitalization. Conclusion: The combination of SGLT2i and ARNI demonstrates superior efficacy in reducing heart failure hospitalization compared to SGLT2i and ARB in diabetic patients with HFrEF, particularly among older adults and males.

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References

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