Table 2.

Meta-analysis studies of ARNI in HFrEF.

Study	Number of studies included in meta-analysis	Number of patients	Treatment groups	Outcomes
Nielsen EE, et al23	48 trials	19,086 patients	ARNI	ARNI reduced the risk of death by 15 % and hospitalization by 15 % as compared to the control group.
				No difference was observed between ARNI and control in reducing myocardial infarction.
				No evidence of a difference between ARNI compared with control on angioedema.
Xie W, et al24	21 trials	69,229 patients	ACEI ARB ARNI	The most efficacious therapy for preventing HHF was ARNI, followed by combination therapy with an ARB plus an ACEI
Tromp J, et al25	75 relevant trials	95,444 patients	ACEI, ARB, BB, MRA, digoxin, hydralazine-isosorbide dinitrate, ivabradine, ARNI, SGLT2i, vericiguat, and omecamtiv-mecarbil	A combination of ARNI, BB, MRA, and SGLT2i was the most effective in reducing all-cause death
Wang Y, et al26	20 studies	10,175 patients	ARNI vs ACEI ARNI vs ARB	ARNI improved functional capacity in patients with HFrEF increasing NYHA functional class and 6-min walking distance.
				In patients of HFpEF treatment with ARNI there were no significant improvements in various indices except left ventricular mass index.
				There were improvements in cardiac reverse remodelling indices at 3 months and were also noted with longer follow-up to 12 months.

Note:- ARNI: angiotensin receptor-neprilysin inhibitor, ACEI: angiotensin converting enzyme inhibitor; ARB: angiotensin receptor blocker; BB: beta blocker, MRA: mineralocorticoid receptor antagonist; SGLT2i: sodium-glucose cotransporter-2 inhibitor; HFrEF: heart failure with reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction; CV: cardiovascular; HHF: hospitalisation for heart failure; NYHA: New York Heart Association.