Physicians' Academy for Cardiovascular Education

ARNI use safe and effective in elderly HFrEF patients

Sacubitril/Valsartan is useful and safe in elderly people with heart failure and reduced ejection fraction. Data from a real-word cohort

Literature - Esteban-Fernández A, Díez-Villanueva P, Vicent L et al., - Rev Esp Geriatr Gerontol. 2019.

Introduction and methods

Prevalence of HF increases with age [1-4]. However, in clinical HF trials elderly patients are underrepresented as the mean age lies below 65 years [5,6]. HF medication with impact on survival are less frequently used in the elderly population due to a lack of evidence, more adverse effects, higher prevalence of comorbidities and lower adherence [7-9]. The PARADIGM-HF study showed that Sacubitril/Valsartan (S/V) reduced the risk of CV mortality and HF hospitalization in symptomatic HFrEF patients [6]. A sub-analysis with patients over 65 years of age showed that this population also benefits from treatment with S/V with similar safety [10]. However, due to lower incidence of the primary outcome in elderly patients compared to other trials and restricted inclusion criteria in PARADIGM-HF, an evaluation of S/V in real-world cohort of elderly patients was desired.

This study performed a prospective registry of elderly HFrEF patients who started S/V in clinical practice in 10 hospitals of Madrid Autonomic Community. 427 Patients were enrolled, with a mean age of 68.1 ± 12.4 years. 222 (52.0%) Were <70 years of age, 140 (32.8%) were between 70 and 79 years and 65 (15.2%) were ≥80 years. The mean follow-up was 7.0 ± 0.1 months. Occurrence of events (death, emergency room visits and hospitalization), S/V adverse effects, clinical characteristics, and maximum tolerated dose and drug withdrawal were analyzed.

Main results


This prospective registry study of real-world data of elderly HFrEF patients who received S/V, suggests that S/V is safe and effective in elderly patients. No age-related differences were found in the prevalence of adverse events. More older patients (≥ 80 years) achieved a lower dose compared to younger patients (<70 years).


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Find this article online on Rev Esp Geriatr Gerontol.

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