{
  "abstract": "Aims: We investigated whether switching from traditional renin–angiotensin system (RAS) blockade to angiotensin receptor–neprilysin inhibitor (ARNI) is associated with a lower risk of new-onset atrial fibrillation (AF) than continuing RAS blockade in patients with heart failure with reduced ejection fraction (HFrEF) without prior AF.\n\nMethods and results: Using data from the Korean National Health Insurance Service (2017–2021), we identified 39 061 patients with HFrEF without prior AF who received either ARNI (n = 12 263) or traditional RAS blockade (n = 26 798). After 1:1 propensity score matching, 9030 patients were included in each group. The primary outcome was new-onset AF within 1 year. In the propensity score–matched cohort, new-onset AF incidence was lower in the ARNI group [10.73 vs. 12.15 per 100 person-years; hazard ratio (HR) 0.89; 95% confidence interval (CI) 0.81–0.98; P = 0.021]. The composite outcome (new-onset AF, ischaemic stroke, or all-cause death) was also reduced (HR 0.85; 95% CI 0.79–0.92; P < 0.001). In competing risk analysis, ARNI was associated with a lower subdistribution hazard of new-onset AF (sHR 0.73; 95% CI 0.58–0.91; P = 0.005). In the unmatched cohort, the HR was 0.85 (95% CI 0.75–0.96) in an exploratory model including age, sex, hypertension, chronic kidney disease, prior ischaemic stroke, socioeconomic status, residential region, and beta-blocker use, and 0.94 (95% CI 0.87–1.02) after adjustment for all measured baseline covariates.\n\nConclusion: 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.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "name": "Young Jun Park",
      "orcid": "0000-0002-1461-5597"
    },
    {
      "name": "Dong-Hyuk Cho",
      "orcid": "0000-0001-8480-9082"
    },
    {
      "name": "Jimi Choi",
      "orcid": "0000-0003-2834-2718"
    },
    {
      "name": "Jong-Chan Youn",
      "orcid": "0000-0003-0998-503X"
    },
    {
      "name": "Mi-Na Kim",
      "orcid": "0000-0001-6589-5122"
    },
    {
      "name": "Chan Joo Lee",
      "orcid": "0000-0002-8756-409X"
    },
    {
      "name": "Jung-Woo Son",
      "orcid": "0000-0002-1790-3228"
    },
    {
      "name": "Byung-Su Yoo",
      "orcid": "0000-0002-3395-4279"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4vt9t3w1jzm06.bib",
  "cited_by": 1,
  "doi": "10.1093/ehjcvp/pvag074",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13730560/",
  "id": "4vt9t3w1jzm06",
  "issns": [
    "2055-6837",
    "2055-6845"
  ],
  "landing_url": "https://doi.org/10.1093/ehjcvp/pvag074",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00200"
    ],
    [
      "heading",
      "AcademicSubjects/MED00410"
    ],
    [
      "heading",
      "Eurheartj/27"
    ],
    [
      "heading",
      "Eurheartj/29"
    ],
    [
      "heading",
      "Heart Failure"
    ],
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2705|Atrial Fibrillation Management and Outcomes"
    ]
  ],
  "openalex": "W7213324242",
  "pdf_url": null,
  "pmcid": "PMC13730560",
  "pmid": "42740677",
  "published": "2026-09-15",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/4vt9t3w1jzm06.ris",
  "sources": [
    {
      "first_seen": "2026-11-07T12:23:05Z",
      "native_id": "PMC13730560",
      "source": "pmc",
      "url": "https://doi.org/10.1093/ehjcvp/pvag074"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Atrial Fibrillation Management and Outcomes",
      "subfield": "cardiovascular"
    }
  ],
  "title": "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",
  "title_text": "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",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:23:05Z",
  "url": "https://research.draconitic.com/paper/4vt9t3w1jzm06",
  "venue": "European Heart Journal. Cardiovascular Pharmacotherapy",
  "versions": []
}