Comparing treatment strategies for heart failure: a real-world analysis of adding ARNI or SGLT2i to older GDMT

Abstract Background Heart failure (HF) is a global burden with limited treatment options beyond established guideline-directed medical therapy (GDMT). Newer medications, like angiotensin receptor-neprilysin inhibitors (ARNIs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), show promise, but real-world evidence on their effectiveness compared to traditional GDMT is lacking. Objective This study assessed the real-world effectiveness of adding ARNIs and SGLT2i to existing GDMT regimens for various HF types using network meta-analysis (NMA). Methods We analyzed data from observational studies, evaluating the impact of different treatment combinations on all-cause mortality (ACM) and heart failure hospitalization (HFH). Results Adding ARNIs to GDMT significantly reduced ACM compared to older regimens (hazard ratio [HR] 0.59, 95% confidence interval [CI] 0.42-0.84), representing a 41% decrease in mortality risk. SGLT2i+2GDMT demonstrated the most significant HFH reduction (HR 0.16, 95% CI 0.06-0.47), translating to an 84% reduction in hospitalization risk. Conclusion Incorporating ARNIs or SGLT2i into existing GDMT regimens improves real-world outcomes for HF patients, supporting current guideline recommendations. Personalized treatment plans considering individual needs and preferences are crucial for optimal patient care.Network map of All-cause mortalityRelative treatment effects for ACM