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Background <p>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.</p> Objective <p>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.</p> Methods <p>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.</p> Results <p>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, <i>p</i> &lt; 0.001) after initiation. Rates fell from 0.73 (95% CI 0.66–0.80) to 0.53 (95% CI 0.44–0.65, <i>p</i> &lt; 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, <i>p</i> &lt; 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, <i>p</i> &lt; 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 <i>p</i> &lt; 0.05). The rates decreased from 0.35 (95% CI 0.28–0.44) to 0.27 (95% CI 0.20–0.38, <i>p</i> = 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, <i>p</i> &lt; 0.05) in the oldest patients aged ≥ 90 years.</p> Conclusions <p>Broader application of guideline-directed medical therapy in geriatric heart failure with reduced ejection fraction care should be prioritized.</p>

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Effectiveness of Sacubitril/Valsartan in Reducing Hospitalizations in Older Belgian Adults with Heart Failure and Reduced Ejection Fraction: An Age-Stratified Study

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  • 发表日期：

    2025年11月21日

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  • Eléonore Maury,
  • Lorenz Van der Linden,
  • Kris Bogaerts,
  • Ann Belmans,
  • Mieke Jansen

摘要

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.