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

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.