Efficacy of sacubitril‐valsartan and SGLT2 inhibitors in heart failure with reduced ejection fraction: A systematic review and meta‐analysis

BACKGROUND: Sacubitril‐valsartan (SV) monotherapy has been shown to help patients with Heart failure with reduced ejection fraction (HFrEF), but whether adding a sodium‐glucose cotransporter‐2 inhibitor (SGLT2i) improves treatment results even more is unknown. HYPOTHESIS: The goal of this study was to look at the efficacy of SV with additional SGLT2i in HFrEF patients. METHODS: For this study, several databases, such as PubMed, EMBASE, Web of Science, and the Cochrane Library, were searched. A coherent search approach was used for data extraction. Review Manager 5.2 and MedCalc were used for conducting the meta‐analysis and bias analysis. A meta‐regression study correlates patient mean age with primary and secondary outcomes. RESULTS: Seven trials totaling 16 100 patients were included in this meta‐analysis. All‐cause mortality, cardiovascular mortality, and improvement in mean left ventricular ejection fraction (LVEF) were the study's major objectives, while hospitalization for heart failure (HF) was calculated to be its secondary outcome. Our analysis showed that HFrEF patients receiving the combination of SV and SGLT2i had better treatment outcomes than the standard SV monotherapy, with risk ratios of 0.76 (0.65–0.88) for all‐cause mortality, 0.65 (0.49–0.86) for cardiovascular mortality, 1.41 (−0.59 to 3.42) for change in mean LVEF, and 0.80 (0.64–1.01) for hospitalization for HF. According to the regression analysis, older HFrEF patients have higher rates of hospitalization, cardiovascular disease, and overall death. CONCLUSIONS: The combination of SV and SGLT2i may have a greater cardiovascular protective effect and minimize the risk of death or hospitalization due to heart failure in HFrEF.