Real-world study suggests sacubitril/valsartan benefits elderly patients with HF

Preliminary real-world data demonstrated consistent benefits of sacubitril/valsartan for elderly patients with heart failure and reduced left ventricular function (HFrEF), even in those patients who were not fully titrated.

“Although post-hoc analysis of the PARADIGM-HF trial showed an optimal efficacy and safety profile of sacubitril/valsartan in elderly patients with HFrEF, real-world unselected data is needed to better define tolerability and safety in this population,” postulated Dr Andrea Herbst (Azienda Ospedaliero-Universitaria Careggi, Italy) [1]. Thus, Dr Herbst and colleagues analysed registry data of 70 elderly patients with heart failure, enrolled between 2016 and 2020.

The participants had a mean age of 77.3 years, 18.6% were women, the mean ejection fraction was 31.7%, and 28.5% of participants were NYHA class III or IV. Further baseline characteristics were a high burden of cardiovascular and non-cardiovascular comorbidities, e.g. 34.3% had diabetes, 61.4% had hypertension, 51.4% had atrial fibrillation, and 50% had chronic kidney disease. Sacubitril/valsartan treatment was started at a minimum and intermediate dosage for 93% and 7% of patients, respectively. At baseline, around 90% received β-blockers and just under 80% received mineralocorticoid receptor antagonists.

After 12 months, 66 patients remained alive in the study. Of them, 88% were still on sacubitril/valsartan therapy. These patients demonstrated an improvement in function with only 6.9% still in NYHA class III or IV. Also, the mean values for N-terminal pro B-type natriuretic peptide (NT-proBNP) dropped from 3,583 to 2,467 pg/mL, while mean values for systolic blood pressure, serum creatinine, and potassium hardly differed from baseline. Allergic reactions, hypotension, and worsening of renal function were identified as the main causes for suspending sacubitril/valsartan. “Among patients still on treatment, only 11 reached the target dose, while 17 reached the intermediate dosage. Hypotension, worsening of renal function, and hyperkalaemia were principal causes of non-titration,” stated Dr Herbst, who also stressed that a clinical reason for lack of titration could not be uncovered in 17% of cases.

“After 1 year, we found a reduction in percentage of loop diuretic prescription and mineralocorticoid receptor antagonists, a stability in the percentage of prescription of β-blockers, and an increase in the sodium-glucose cotransporter-2 inhibitors rate,” he stated.

The researchers concluded that sacubitril/valsartan was mostly well tolerated in their elderly patients and that those patients who tolerated sacubitril/valsartan were less symptomatic and had an improved bio-humoral profile after 1 year.

1. 
   
   1. Herbst A, et al. Is sacubitril/valsartan well tolerated in elderly heart failure patients with reduced ejection fraction? Preliminary data from a real-word registry. P60565, Heart Failure and World Congress on Acute Heart Failure 2021, 29 June–1 July.

 

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Posted on 19 August 202120 August 2021