{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T14:21:33Z","timestamp":1771856493980,"version":"3.50.1"},"reference-count":36,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"This work received funds from the Deanship of Scientific Research at the University of Jordan","award":["(19\/2023\/1739)"],"award-info":[{"award-number":["(19\/2023\/1739)"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,21]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Heart failure (HF) is associated with complex symptoms and frequent hospitalisation that reduce patients\u2019 quality of life (QoL). This study aims to assess the association between angiotensin receptor-neprilysin inhibitor (ARNI) use and changes in QoL and disease-related outcomes among patients with HF in Jordan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective observational cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>The study was conducted among patients with HF attending the outpatient cardiology clinics at Jordan University Hospital, a tertiary care centre in Amman, Jordan. Patients either initiated on ARNI or receiving angiotensin-converting enzyme inhibitor (ACEI)\/angiotensin receptor blocker (ARB) were included in the study at a 1:2 ratio. All participants were followed up for up to 1 year after recruitment. The study period was from 4 February 2024 to 29 May 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Data on QoL, New York Heart Association (NYHA) functional class and left ventricular ejection fraction (LVEF) were collected at baseline and after 3\u2009months of treatment. Hospitalisation data were collected for the preceding year and the year following participants\u2019 recruitment. Medication adherence and ARNI side effects were assessed after 3-month of follow-up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 227 patients with HF were included; 74 were initiated on ARNI, and 153 were receiving ACEIs\/ARBs. At baseline, significantly lower QoL scores and LVEF were observed in the ARNI group compared with the ACEIs\/ARBs group. After 3-month, the ARNI group showed improvements in all QoL scores, NYHA functional class and LVEF (p&lt;0.05). Worsened QoL scores (symptom stability, symptom burden, self-efficacy domains and clinical summary score) were detected within the ACEIs\/ARBs group (p&lt;0.05). One-year post-recruitment a significant reduction in cardiovascular and all-cause hospitalisations (p&lt;0.05) was observed in the ARNI group compared with the ACEIs\/ARBs group. Adherence levels assessed after 3\u2009months of treatment were shown to be high in both study groups (p=0.558). The main ARNI side effect was hypotension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ARNI use was associated with favourable QoL, NYHA class, and LVEF as well as lower hospitalisation rates among patients with HF in Jordan. The safety profile was consistent with previous studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111865","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T13:35:30Z","timestamp":1771853730000},"page":"e111865","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association between angiotensin receptor-neprilysin inhibitor use and clinical outcomes in patients with heart failure: a 1-year prospective cohort study from Jordan"],"prefix":"10.1136","volume":"16","author":[{"given":"Rama S","family":"Odeh","sequence":"first","affiliation":[{"name":"Department of Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3976-5444","authenticated-orcid":false,"given":"Mariam","family":"Abdel Jalil","sequence":"additional","affiliation":[{"name":"Department of Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Ali","family":"Qudah","sequence":"additional","affiliation":[{"name":"Department of Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanna K","family":"Al-Makhamreh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, The University of Jordan, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akram","family":"Saleh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, The University of Jordan, Amman, Jordan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1750-6684","authenticated-orcid":false,"given":"Oriana","family":"Awwad","sequence":"additional","affiliation":[{"name":"Department of Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, Jordan"},{"name":"Diagnostics and Public Health, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"2026022305351460000_16.2.e111865.1","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvac013"},{"key":"2026022305351460000_16.2.e111865.2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2115"},{"key":"2026022305351460000_16.2.e111865.3","doi-asserted-by":"crossref","DOI":"10.1177\/23779608241242023","article-title":"Symptom Burden and Quality of Life Among Patients With Heart Failure","volume":"10","author":"Al-Sutari","year":"2024","journal-title":"SAGE Open Nurs"},{"key":"2026022305351460000_16.2.e111865.4","doi-asserted-by":"crossref","DOI":"10.1177\/23779608231189128","article-title":"Consequences of Psychological Aspects: From Jordanian Heart Failure Patients\u2019 Beliefs","volume":"9","author":"Sumaqa","year":"2023","journal-title":"SAGE Open Nurs"},{"key":"2026022305351460000_16.2.e111865.5","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.2147\/IJGM.S465388","article-title":"Comparative Analysis of Heart Failure with Preserved Vs Reduced Ejection Fraction: Patient Characteristics, Outcomes, Mortality Prediction, and Machine Learning Model Development in the JoHFR","volume":"17","author":"Izraiq","year":"2024","journal-title":"Int J Gen Med"},{"key":"2026022305351460000_16.2.e111865.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0298893","article-title":"Experiences on health-related quality of life of Jordanian patients living with heart failure: A qualitative study","volume":"19","author":"Saifan","year":"2024","journal-title":"PLoS One"},{"key":"2026022305351460000_16.2.e111865.7","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2021.754499","article-title":"Sacubitril-Valsartan, Clinical Benefits and Related Mechanisms of Action in Heart Failure With Reduced Ejection Fraction. 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