Date of Award

Spring 5-2025

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Solberg, Julie

Keywords

Angiotensinogen converting enzymes, Angiotensin receptor blockers, Angiotensin-converting/neprilysin inhibitors, Preserved ejection fraction heart failure

Abstract

Heart failure (HF) impacts approximately 6.7 million adults in the United States, with over half classified as heart failure with preserved ejection fraction (HFpEF). As the condition progresses, it can significantly diminish the quality of life and substantially increase the risk of early mortality. This literature review evaluates the effectiveness of angiotensin receptorneprilysin inhibitors (ARNIs) compared to traditional renin-angiotensin system (RAAS) medications in reducing hospitalizations, cardiac deaths, and natriuretic peptide levels in HFpEF patients. A comprehensive search of PubMed and Embase identified 1,033 studies, with eight meeting criteria for final analysis. Sacubitril/valsartan did not significantly reduce hospitalizations or cardiac deaths compared to RAAS therapy but did lower serum biomarkers associated with cardiac fibrosis. These findings highlight the need to tailor HF treatment based on ejection fraction and disease progression. Further large, multi-center studies are necessary to identify sub-populations that may benefit most from ARNI therapy.

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