Heart failure & cardiomyopathiesResearch article
Switching to angiotensin receptor–neprilysin inhibitor and reduced risk of new-onset atrial fibrillation in heart failure with reduced ejection fraction: a nationwide propensity score–matched study
- nationwide propensity score–matched study
- 1:1 propensity score matching
- Korean National Health Insurance Service data (2017-2021)
Authors' conclusion
In this large nationwide cohort of AF-naive patients with HFrEF, switching to ARNI was associated with a lower risk of short-term new-onset AF than continuing traditional RAS blockade. As this was a retrospective study, further prospective studies are needed to confirm these findings.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) without prior atrial fibrillation (AF)patients with HFrEF without prior AF, after 1:1 propensity score matching, 9030 patients in each group · angiotensin receptor-neprilysin inhibitor (ARNI) 12,263 · traditional renin-angiotensin system (RAS) blockade 26,798
- Participants
- 39,061 patients
- Comparison
- ARNI vs traditional RAS blockade
- ARNIn = 9,030
- traditional RAS blockaden = 9,030reference
- Outcome
- new-onset AF
- Follow-up
- Within 1 year
Main finding
As reported in the abstract
Hazard ratio
0.89
95% CI 0.81–0.98
P = 0.021
By group
ARNI vs traditional RAS blockade
HR 0.89 (95% CI 0.81–0.98); P = 0.021
Further findings
| Outcome | Estimate | P value | |
|---|---|---|---|
| Composite outcome (new-onset AF, ischaemic stroke, or all-cause death) | HR 0.85 (95% CI 0.79–0.92) | P < 0.001 | |
| New-onset AF, competing risk analysis | sHR 0.73 (95% CI 0.58–0.91) | P = 0.005 | |
| New-onset AF, unmatched cohort — ARNI vs traditional RAS blockade · unmatched cohort | HR 0.85 (95% CI 0.75–0.96) | ||
| New-onset AF, unmatched cohort — ARNI vs traditional RAS blockade · after adjustment for all measured baseline covariates · unmatched cohort | HR 0.94 (95% CI 0.87–1.02) | ||
| 0.512Ratio (log scale) |
- New-onset AF, unmatched cohort: exploratory model including age, sex, hypertension, chronic kidney disease, prior ischaemic stroke, socioeconomic status, residential region, and beta-blocker use
Original publication
Switching to angiotensin receptor–neprilysin inhibitor and reduced risk of new-onset atrial fibrillation in heart failure with reduced ejection fraction: a nationwide propensity score–matched study. Eur Heart J Cardiovasc Pharmacother. Published 15 September 2026. doi:10.1093/ehjcvp/pvag074
Summarised from the published abstract; every number is checked against it