Angiotensin receptor-neprilysin inhibitor treatment in people with chronic obstructive pulmonary disease and heart failure.

BACKGROUND: While renin-angiotensin system inhibitors (RASi) have shown benefits for people with both heart failure (HF) and chronic obstructive pulmonary disease (COPD), limited data exists on the use of angiotensin receptor-neprilysin inhibitors (ARNIs) in this population. This study compares the effectiveness of RASi and ARNIs in people with coexisting COPD and HF. METHODS: We identified individuals who started treatment with either ARNI or RASi since August 1, 2015. We assessed outcomes such as COPD exacerbations, acute respiratory failure, and lower respiratory tract infections (LRTIs) over 30 days to 3 years. Kaplan-Meier survival analysis and Cox regression models were applied to estimate survival probabilities and hazard ratios (HR). RESULTS: Among 9,071 ARNI users and 71,836 RASi users, the ARNI group has fewer respiratory complications. The ARNI group has a higher proportion of females compared to the RASi group (38.2% vs. 31.5%). Specifically, ARNI users have a lower incidence of COPD exacerbations (13.1% vs. 18.7%; HR, 0.84), acute respiratory failure (16.2% vs. 22.0%; HR, 0.90), and LRTIs (16.9% vs. 22.9%; HR, 0.91). CONCLUSIONS: In people with both COPD and HF, ARNI treatment is associated with fewer respiratory complications compared to RASi.