Key result
Sacubitril/valsartan initiation is linked to a ~28% drop in annual CV hospitalizations in older HFrEF.
Why the study?
Heart failure with reduced ejection fraction is increasingly prevalent in older adults, yet data on guideline-directed therapies in the oldest age groups remain limited.
Does sacubitril/valsartan reduce hospitalizations and mortality in older adults (≥75 years) with HFrEF?
Cohort (n=1,705)
Does sacubitril/valsartan reduce hospitalizations and mortality in older adults (≥75 years) with HFrEF?
Sacubitril/valsartan initiation in older adults (≥75 years) with HFrEF is associated with significant reductions in cardiovascular and heart failure hospitalizations across all age strata, including those ≥90 years.
May support sacubitril/valsartan in HFrEF patients ≥75 years; leaves open need for randomized confirmation in oldest subgroups.
BACKGROUND: Heart failure with reduced ejection fraction is increasingly prevalent in older adults, yet data on guideline-directed therapies in the oldest age groups remain limited. OBJECTIVE: To assess outcomes of sacubitril/valsartan in adults aged ≥75 years, across age strata (≥75, ≥80, ≥85, ≥90 years; 75-79, 80-84, 85- 89 years), focusing on cardiovascular, heart failure, and all-cause hospitalizations, and mortality. METHODS: This retrospective study evaluated all patients aged ≥ 75 years in Belgium with chronic heart failure with reduced ejection fraction who started sacubitril/valsartan between 1 November, 2016 and 31 December, 2018. RESULTS: A total of 1705 patients were divided into the following age groups: 75-79, 80-84, 85-89, and ≥ 90 years. Cardiovascular hospitalization rates significantly decreased across all age groups after sacubitril/valsartan initiation. Patients aged 75-79 years showed a reduction from 0.74 events/year (95% confidence interval [CI] 0.68-0.81) prior to treatment to 0.54 (95% CI 0.47-0.62, p < 0.001) after initiation. Rates fell from 0.73 (95% CI 0.66-0.80) to 0.53 (95% CI 0.44-0.65, p < 0.001) in those aged 80-84 years, from 0.62 (95% CI 0.52-0.74) to 0.44 (95% CI 0.35-0.57, p < 0.01) in those aged 85-89 years, and from 0.78 (95% CI 0.59-1.03) to 0.42 (95% CI 0.22-0.83, p < 0.01) in patients aged ≥ 90 years. Heart failure-related hospitalization rates also showed consistent reductions: 0.34 (95% CI 0.30-0.39) prior to treatment to 0.28 (95% CI 0.22-0.34) after initiation in patients aged 75-79 years, and from 0.38 (95% CI 0.33-0.43) to 0.30 (95% CI 0.23-0.39) in those aged 80-84 years (all p < 0.05). The rates decreased from 0.35 (95% CI 0.28-0.44) to 0.27 (95% CI 0.20-0.38, p = 0.08) in those aged 85-89 years and from 0.52 (95% CI 0.36-0.76) to 0.29 (95% CI 0.12-0.75, p < 0.05) in the oldest patients aged ≥ 90 years. CONCLUSIONS: Broader application of guideline-directed medical therapy in geriatric heart failure with reduced ejection fraction care should be prioritized.
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Maury et al. (2025) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=1,705). Sacubitril/Valsartan vs. Pre-treatment period (within-patient comparison) was evaluated on Annual cardiovascular hospitalization rate (events/year) (p=<0.0001). Sacubitril/valsartan initiation significantly reduced the annual cardiovascular hospitalization rate from 0.72 to 0.52 events per year in adults aged 75 years and older with heart failure and HFrEF.
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