Nikhil Prasad Fact checked by:Thailand Medical News Team Sep 19, 2026 41 minutes ago
The widely used heart failure treatment sacubitril/valsartan has been linked to a lower risk of developing atrial fibrillation (AF) in people with heart failure with reduced ejection fraction (HFrEF), according to a large nationwide South Korean study.
Sacubitril/valsartan was associated with a lower one-year risk of new-onset atrial fibrillation among patients with heart failure and reduced ejection fraction
Researchers examined 39,061 patients with HFrEF who had no previous history of AF. Among them, 12,263 switched from conventional renin-angiotensin system (RAS) blockade to an angiotensin receptor-neprilysin inhibitor (ARNI), specifically sacubitril/valsartan, while 26,798 continued traditional RAS-blocking treatment.
Nationwide Data Provide a Large Comparison
The researchers were from Korea University Anam Hospital and Korea University College of Medicine; Seoul St. Mary’s Hospital, the Catholic Research Institute for Intractable Cardiovascular Disease, and Catholic University of Korea; Severance Hospital and Yonsei University College of Medicine; and Yonsei University Wonju College of Medicine.
Using Korean National Health Insurance Service data from 2017 through 2021, the researchers used propensity-score matching to create two more comparable groups containing 9,030 patients each. The primary outcome was newly diagnosed AF within one year.
Sacubitril/Valsartan Linked to 11% Lower AF Hazard
Among matched patients, 805 people receiving sacubitril/valsartan developed AF compared with 880 continuing traditional RAS blockade. Incidence rates were 10.73 and 12.15 cases per 100 person-years, respectively.
The difference corresponded to an 11% lower relative hazard of new-onset AF with ARNI treatment, with a hazard ratio of 0.89. The result was statistically significant.
Importantly, this
Thailand Medical News report also found that the composite outcome of new-onset AF, ischemic stroke, or death from any cause was 15% lower in the ARNI group. All-cause mortality was also lower, with a hazard ratio of 0.86.
When death was treated as a competing event, sacubitril/valsartan was associated with a 27% lower subdistribution hazard of developing AF. Older age, male sex, and previous ischemic stroke were associated with increased AF risk, whereas ARNI and beta-blocker use were associated with lower risk.
How the Treatment Might Affect AF Risk
Researchers proposed that sacubitril may increase natriuretic peptide activity, promoting sodium excretion and vasodilation while reducing pressure and volume overload in the left atrium. These effects could potentially limit atrial stretching, fibrosis, enlargement, and structural remodeling that contribute to AF. However, these mechanisms were not directly measured.
Conclusions
The findings suggest sacubitril/valsartan may provide an additional benefit for patients with HFrEF by lowering short-term new-onset AF risk. However, the observational study cannot
establish that the drug directly prevents AF, and prospective studies are needed to confirm the association and determine whether it persists across broader populations and longer follow-up periods.
The study findings were published in the peer reviewed European Heart Journal – Cardiovascular Pharmacotherapy.
https://academic.oup.com/ehjcvp/advance-article/doi/10.1093/ehjcvp/pvag074/8795225
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