Real-World Impact of ARNI and SGLT2 Inhibitors in Heart Failure: Insights for Primary Care

A retrospective longitudinal cohort of 1,363 patients with HFrEF found that the period of wider adoption of contemporary disease‑modifying therapies coincided with modest ventricular recovery and lower two‑year mortality.

The single‑center retrospective cohort evaluated one‑year LVEF change, device implantation rates, and two‑year all‑cause mortality among 1,363 patients with HFrEF. Mean LVEF rose from 42.1% to 44.3% (p = 0.005), ICD implantation declined from 11.1% to 7.2% (p = 0.016), and cumulative two‑year mortality decreased from 9.4% to 5.9% (p = 0.023). These represent modest absolute improvements and support the hypothesis that contemporary therapies may improve outcomes in routine care; confirmation in other real‑world cohorts or prospective studies is warranted.

Mean ventricular function increased by 2.2 percentage points at one year and this remodeling signal coincided with a lower rate of device implantation in the later period. The cohort‑level decrease in ICD procedures (11.1% to 7.2%) and lower downstream procedural need tracked with improved LVEF and treatment optimization. Together, these findings support closer echocardiographic follow‑up before committing to device implantation.

All‑cause mortality fell from 9.4% to 5.9% over two years—an absolute reduction of approximately 3.5 percentage points that was significant in unadjusted and baseline‑adjusted analyses. Multivariable models that further adjusted for baseline treatments attenuated the period effect and rendered it non‑significant, suggesting that changes in therapy use may have contributed but do not establish causation.

Key Takeaways:

• Real‑world adoption of modern HFrEF therapies in a 1,363‑patient cohort was associated with a mean LVEF increase (42.1% → 44.3%), reduced ICD use (11.1% → 7.2%), and lower two‑year mortality (9.4% → 5.9%).
• These numerical changes—an absolute ~2.2 percentage‑point LVEF gain and ~3.5 percentage‑point mortality reduction—are clinically relevant and support prioritizing medication initiation and up‑titration in primary care.
• Operationally, primary care should implement early initiation and titration protocols, set echocardiographic reassessment at 3–6 months, and coordinate device referrals to account for potential treatment‑related remodeling.