The real-world use of benefit-unproven ARBs in HFrEF: clinical outcomes and prescription patterns
Abstract
In the contemporary landscape of heart failure (HF) management, angiotensin II receptor blockers (ARBs) remain widely used despite the advent of angiotensin receptor–neprilysin inhibitors. Among available ARBs, only valsartan, candesartan, and losartan have demonstrated clinical benefit in patients with heart failure with reduced ejection fraction (HFrEF; LVEF <40%) (hereafter, benefit-proven ARBs). The clinical outcomes associated with other ARBs in HFrEF (benefit-unproven ARBs) remain uncertain.
To describe real-world ARB prescription patterns in HFrEF and compare clinical outcomes between benefit-proven and benefit-unproven ARBs.
Using the National Health Insurance Service database, we identified adult patients with HFrEF receiving guideline-directed background therapy (renin–angiotensin system inhibitor [RASi], beta-blocker, mineralocorticoid receptor antagonist, and loop diuretic) between January 2008 and December 2015. We compared the incidence of a 5-year composite outcome (all-cause death, HF hospitalization, or heart transplantation) between patients prescribed benefit-unproven ARBs (eprosartan, fimasartan, irbesartan, olmesartan, and telmisartan) and those receiving benefit-proven ARBs.
A total of 3,879 HFrEF patients receiving background therapy were included (mean age 57.8±13.7 years; 67.8% male). Among 2,731 ARB prescriptions, candesartan (860, 31.5%), valsartan (800, 29.3%), and losartan (451, 16.5%) were most common, followed by telmisartan (228, 8.3%),…
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