This observational cohort included 9,107 patients hospitalized for acute heart failure with mildly reduced or preserved ejection fraction and used propensity score overlap weighting. Comparing in-hospital sacubitril/valsartan initiation with ARB therapy, rates of HF rehospitalization or cardiovascular death were 39.7 versus 40.3 per 100 person-years (hazard ratio 0.97; 95% confidence interval 0.79–1.20). Associations were consistent across kidney-function strata, including dialysis. Greater NT-proBNP reduction in a biomarker subcohort did not translate into an observed reduction in clinical events, and limited sample size prevented conclusions of therapeutic equivalence.
Sacubitril/valsartan initiation was not associated with fewer HF rehospitalizations or cardiovascular deaths than ARB therapy in this cohort. The confidence interval does not establish equivalence.
Study limitation: The observational design leaves potential residual confounding despite overlap weighting, and limited sample size precludes definitive equivalence conclusions.
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