Characteristics of Heart Failure Patients with Reduced Left Ventricular Ejection Fraction (HFrEF) Using Angiotensin Receptor-Neprilysin Inhibitors (ARNI) Compared to Angiotensin Converting Enzyme-Inhibitor (ACE-I)/Angiotensin Receptor Blocker (ARB) Therap

Abstract

BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) remains a major cause of cardiovascular morbidity. While guideline-directed medical therapy, including Angiotensin Receptor Neprylisin Inhibitor (ARNI) dan Angiotensin Converting Enzyme-Inhibitor (ACE-I)/Angiotensin Receptor Blocker (ARB), is well-established, real-world clinical profiling of these patients in Indonesia remains limited.

OBJECTIVES: To evaluate and compare the baseline clinical, demographic, and pharmacological characteristics of HFrEF patients receiving ARNI versus ACE/ARB therapies at Haji Adam Malik Hospital, Medan.

METHODS: This cross-sectional, descriptive study was conducted at the integrated heart center polyclinic from August to December 2025. We consecutively enrolled 50 eligible HFrEF outpatients, consisting of 25 patients receiving ACE/ARB and 25 patients receiving ARNI therapies. Data regarding demographics, medical history, and medication records were extracted and analyzed.

RESULTS: The cohort had an overall mean age of 57.6 years and was predominantly male (78%). The primary underlying etiology was Ischemic Cardiomyopathy (86%). Key comorbidities included hypertension (54%) and diabetes mellitus (32%). Overall analysis demonstrated that demographic and clinical parameters, including age, systolic blood pressure, and comorbidities, were not significantly different between patients receiving ACE/ARB and those receiving ARNI (all p > 0.05).

CONCLUSION: HFrEF patients in our center are predominantly male with an ischemic etiology and a significant burden of cardiometabolic comorbidities. Baseline clinical profiles are highly comparable between those prescribed ARNI and ACE/ARB therapies, providing valuable real-world data for the optimization of HFrEF management.