Use and Benefit of Sacubitril/Valsartan in Elderly Patients with Heart Failure with Reduced Ejection Fraction
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Selection and Study Design
2.2. Data Collection
2.3. Outcomes and Follow-Up
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total Population (N = 616) | ARNI (after Propensity Score Matching) (N = 258) | |||
---|---|---|---|---|
Yes (N = 86) | No (N = 172) | p-Value | ||
Age, years ± SD | 83.3 ± 5.1 | 80.6 ±3.8 | 80.9 ± 4.3 | NS |
Male, n (%) | 404 (65.6) | 60 (69.8) | 115 (66.9) | NS |
High blood pressure, n (%) | 500 (81.2) | 67 (77.9) | 139 (80.8) | NS |
Diabetes mellitus, n (%) | 218 (35.4) | 29 (33.7) | 62 (36.0) | NS |
Hyperlipidemia, n (%) | 352 (57.1) | 48 (55.8) | 93 (54.1) | NS |
Current smoker, n (%) | 253 (41.1) | 41 (47.7) | 71 (41.3) | NS |
BMI > 30kg/m2, n (%) | 66 (10.7) | 9 (10.5) | 28 (16.3) | NS |
Chronic lung disease, n (%) | 109 (17.7) | 16 (18.6) | 37 (21.5) | NS |
Stroke/TIA, n (%) | 100 (16.2) | 9 (10.5) | 13 (7.6) | NS |
Peripheral artery disease, n (%) | 78 (12.7) | 11 (12.8) | 17 (9.9) | NS |
Chronic liver disease, n (%) | 14 (2.3) | 1 (1.2) | 3 (1.7) | NS |
Chronic kidney disease, n (%) | 330 (53.6) | 42 (48.8) | 74 (43.0) | NS |
Cognitive impairment, n (%) | 75 (12.1) | 0 (0) | 11 (8.2) | NS |
Functional disability, n (%) | 94 (15.3) | 8 (9.3) | 11 (6.4) | NS |
LVEF, % ± SD | 28.5 ± 7.8 | 28.6 ± 7.5 | 28.4 ± 8.0 | NS |
Ischemic LV dysfunction, n (%) | 287 (53.9) | 50 (59.5) | 79 (51) | NS |
Previous HF admission, n (%) | 269 (43.7) | 34 (39.5) | 78 (45.3) | NS |
QRS > 120 ms, n (%) | 155 (60.3) | 56 (65.9) | 99 (57.6) | NS |
Sinus rhythm, n (%) | 361 (58.7) | 50 (41.2) | 101 (41.3) | NS |
GFR, mL/min/1.73 m2, ± SD | 56.9 ± 18.4 | 60.8 ± 14.8 | 60.4 ± 17.8 | NS |
Hemodialysis, n (%) | 13 (2.1) | 0(0) | 5 (2.9) | NS |
NYHA class | ||||
I–II, n (%) | 519 (86.8) | 73 (90.1) | 149 (87.1) | NS |
III–IV, n (%) | 79 (13.2) | 8 (9.9) | 22 (12.9) | NS |
Beta-blockers, n (%) | 474 (76.9) | 78 (90.7) | 139 (80.8) | NS |
ACEi/ARB, n (%) | 342 (55.5) | – | 114 (66.3) | – |
MRA, n (%) | 249 (40.4) | 50 (58.1) | 78 (45.3) | NS |
SGLT2i, n (%) | 26 (4.2) | 15 (17.4) | 7 (4.1) | 0.001 |
Diuretics, n (%) | 442 (71.8) | 67 (77.7) | 123 (71.5) | NS |
Digoxin, n (%) | 60 (9.7) | 4 (4.7) | 15 (8.7) | NS |
Ivabradine, n (%) | 27 (4.4) | 7 (8.1) | 7 (4.1) | NS |
Amiodarone, n (%) | 68 (11.0) | 10 (11.6) | 20 (11.6) | NS |
Anticoagulation, n (%) | 296 (48.1) | 47 (54.7) | 88 (51.2) | NS |
ICD/CRT, n (%) | 65 (16.6) | 19 (22.1) | 20 (11.6) | NS |
Univariate Analysis | Multivariate Analysis | |||
---|---|---|---|---|
HR | 95% CI | HR | 95% CI | |
Age | 1.09 | 1.07–1.12 | 1.05 | 1.02–1.08 |
Sex | 0.97 | 0.77–1.37 | ||
High blood pressure | 1.02 | 0.76–1.77 | ||
Diabetes mellitus | 1.27 | 1.01–1.60 | 1.36 | 1.07–1.72 |
Hyperlipidemia | 1.10 | 0.87–1.38 | ||
Chronic lung disease | 1.30 | 0.98–1.71 | ||
Stroke/TIA | 1.17 | 0.87–1.57 | ||
GFR | 0.99 | 0.98–0.99 | 0.99 | 0.98–0.99 |
Functional disability | 0.40 | 0.26–0.61 | 1.28 | 1.04–1.58 |
Ischemic LV dysfunction | 1.35 | 1.05–1.73 | ||
Previous HF admission | 1.32 | 1.06–1.66 | ||
QRS > 120 ms | 0.84 | 0.64–1.11 | ||
No sinus rhythm | 1.22 | 0.98–1.54 | 1.33 | 1.06–1.68 |
LVEF | 0.99 | 0.98–1.00 | ||
LVEF improvement | 0.48 | 0.36–0.62 | 0.49 | 0.37–0.64 |
NYHA class III–IV | 1.26 | 0.92–1.74 | ||
Beta-blockers | 0.53 | 0.41–0.67 | 0.62 | 0.48–0.80 |
ARNI | 0.27 | 0.16–0.44 | 0.36 | 0.21–0.61 |
ACEi/ARB | 0.88 | 0.70–1.10 | ||
MRA | 1.09 | 0.83–1.44 | ||
SGLT2i | 0.12 | 0.03–0.50 | ||
ICD/CRT | 0.53 | 0.35–0.82 |
Univariate Analysis | Multivariate Analysis | |||
---|---|---|---|---|
HR | 95% CI | HR | 95% CI | |
Age | 1.06 | 1.04–1.08 | 1.04 | 1.02–1.07 |
Sex | 0.99 | 0.80–1.22 | ||
High blood pressure | 1.16 | 0.89–1.52 | ||
Diabetes mellitus | 1.23 | 1.00–1.51 | 1.32 | 1.07–1.63 |
Hyperlipidemia | 1.10 | 0.90–1.35 | ||
Chronic lung disease | 1.29 | 1.00–1.66 | ||
Stroke/TIA | 1.15 | 0.88–1.49 | ||
GFR | 0.99 | 0.98–0.99 | 0.99 | 0.98–1.00 |
Ischemic LV dysfunction | 1.14 | 0.92–1.42 | ||
Previous HF admission | 1.43 | 1.17–1.75 | 1.36 | 1.1–1.68 |
QRS > 120 ms | 1.09 | 0.89–1.35 | ||
Non-sinus rhythm | 1.28 | 1.05–1.57 | 1.32 | 1.07–1.62 |
LVEF | 0.99 | 0.98–1.00 | ||
LVEF improvement | 0.67 | 0.53-0.83 | 0.72 | 0.57–0.90 |
NYHA class III–IV | 1.09 | 0.81–1.46 | ||
Beta-blockers | 0.64 | 0.51–0.79 | 0.70 | 0.49–0.88 |
ARNI | 0.27 | 0.16–0.44 | 0.69 | 0.49–0.99 |
ACEi/ARB | 0.72 | 0.59–0.88 | 0.68 | 0.54–0.85 |
MRA | 1.01 | 0.82–1.24 | ||
SGLT2i | 0.43 | 0.22–0.83 | ||
ICD/CRT | 0.79 | 0.56–1.11 |
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Roca, L.N.; García, M.C.; Germán, J.B.; Becerra, A.J.B.; Otero, J.M.R.; Chapel, J.A.E.; López, C.R.; Lázaro, A.M.P.; Urquía, M.T.; Tuñón, J. Use and Benefit of Sacubitril/Valsartan in Elderly Patients with Heart Failure with Reduced Ejection Fraction. J. Clin. Med. 2024, 13, 4772. https://doi.org/10.3390/jcm13164772
Roca LN, García MC, Germán JB, Becerra AJB, Otero JMR, Chapel JAE, López CR, Lázaro AMP, Urquía MT, Tuñón J. Use and Benefit of Sacubitril/Valsartan in Elderly Patients with Heart Failure with Reduced Ejection Fraction. Journal of Clinical Medicine. 2024; 13(16):4772. https://doi.org/10.3390/jcm13164772
Chicago/Turabian StyleRoca, Luis Nieto, Marcelino Cortés García, Jorge Balaguer Germán, Antonio José Bollas Becerra, José María Romero Otero, José Antonio Esteban Chapel, Carlos Rodríguez López, Ana María Pello Lázaro, Mikel Taibo Urquía, and José Tuñón. 2024. "Use and Benefit of Sacubitril/Valsartan in Elderly Patients with Heart Failure with Reduced Ejection Fraction" Journal of Clinical Medicine 13, no. 16: 4772. https://doi.org/10.3390/jcm13164772