AIM  To explore the impact of angiotensin receptor neprilysin inhibitor on the prognosis of heart failure with mid-range ejection fraction (HFmrEF).

  METHODS  Patients who were diagnosed with chronic heart failure and had the left ventricular ejection fraction (LVEF) between 40% and 49% in Hebei General Hospital from January, 2019 were consecutively enrolled. Eighty-six patients were divided into two groups with forty-three in each group, and the patients in the two groups were separately treated with oral sacubitril-valsartan and oral perindopril titrated, gradually from low dose to target dose on the basis of standard treatment of heart failure. Baseline data were collected, including demographic information, vital signs, NYHA class, history of comorbidities, history of drug use, biomarkers, echocardiography and six minute walking test (6MWT). After one-year follow up, NT-proBNP, LVEF, 6MWT, changes of NYHA class, rates of death, readmission for heart failure and the composite outcome of death and readmission for heart failure were reassessed.

  RESULTS  Eighty-six patients diagnosed with HFmrEF were enrolled. The baseline data were balanced in the two groups without significant difference. The level of NT-proBNP decreased and LVEF increased in both groups (P<0.05), but no difference was observed between the two groups. The distance of 6MWT and NYHA class improved in both groups but sacubitril-valsartan achieved better results (P<0.01). The one-year death rate in sacubitril-valsartan group and perindopril group was P<0.05. The composite outcome of death and readmission for heart failure in the two groups was P<0.05.

  CONCLUSION  Angiotensin receptor neprilysin inhibitor not only improves symptoms and exercise capacity, but also reduces the rate of readmission for heart failure and the composite outcome of death and readmission for heart failure in HFmrEF.