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
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.
Methods 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.
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.
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BibTeX
@article{park2026switching,
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}},
author = {Young Jun Park and Dong-Hyuk Cho and Jimi Choi and Jong-Chan Youn and Mi-Na Kim and Chan Joo Lee and Jung-Woo Son and Byung-Su Yoo},
journal = {European Heart Journal. Cardiovascular Pharmacotherapy},
year = {2026},
month = sep,
doi = {10.1093/ehjcvp/pvag074},
url = {https://doi.org/10.1093/ehjcvp/pvag074},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Young Jun Park
AU - Dong-Hyuk Cho
AU - Jimi Choi
AU - Jong-Chan Youn
AU - Mi-Na Kim
AU - Chan Joo Lee
AU - Jung-Woo Son
AU - Byung-Su Yoo
PY - 2026
DA - 2026/09/15
JO - European Heart Journal. Cardiovascular Pharmacotherapy
DO - 10.1093/ehjcvp/pvag074
UR - https://doi.org/10.1093/ehjcvp/pvag074
AB - 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. Methods 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. 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.
SN - 2055-6837
SN - 2055-6845
ER -