Heart failure & cardiomyopathiesRandomised controlled trial

Sacubitril/Valsartan vs Enalapril in Heart Failure Due to Chagas Disease

JAMAPublished

  • Randomised controlled trial
  • multicentre (83 sites)

Authors' conclusion

In patients with HF with reduced ejection fraction due to Chagas disease, there was no significant difference in clinical outcomes between sacubitril/valsartan and enalapril, but there was a greater reduction in NT-proBNP at 12 weeks in patients in the sacubitril/valsartan group.

Study context

Population
Patients with HFrEF (LVEF ≤40%, elevated NT-proBNP/BNP) due to Chagas disease, Argentina, Brazil, Colombia and Mexico
Participants
462 vs 460
Comparison
Sacubitril/valsartan vs enalapril
  • Sacubitril/valsartann = 462
  • Enalapriln = 460reference
Primary endpoint
Hierarchical composite of:
  • CV death
  • Heart failure (HF) hospitalization
  • Relative change in NT-proBNP (win ratio)
Follow-up
NT-proBNP change from baseline to 12 weeks

Primary result

Hierarchical composite (win ratio)

Stratified win ratio

1.52

95% CI 1.28–1.82

P < 0.001

Sacubitril/valsartan vs Enalapril
stratified win ratio 1.52 (95% CI 1.28–1.82); P < 0.001

As reported in the abstract

Further findings

CV death (hierarchical component) · median follow-up 25.2 months

wins

First HF hospitalization (hierarchical component)

wins

Decrease in NT-proBNP (hierarchical component) · 12 weeks Sacubitril/valsartan median 30.6% (IQR −54.3%–-0.9%) · Enalapril median 5.5% (IQR −31.9%–37.5%)

wins

Original publication

Sacubitril/Valsartan vs Enalapril in Heart Failure Due to Chagas Disease. JAMA. Published 6 January 2026. doi:10.1001/jama.2025.19808

Summarised from the published abstract; every number is checked against it