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Use of sacubitril-valsartan in elderly patients. Subanalysis of the SAVE-RLife study

Session Poster Session 2

Speaker Mario Galvan Ruiz

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : M Galvan Ruiz (Las Palmas De Gran Canaria,ES), M Sanmamed Giron (Las Palmas De Gran Canaria,ES), M Singh (Las Palmas De Gran Canaria,ES), M Groba Marco (Las Palmas De Gran Canaria,ES), JJ Garcia Salvador (Las Palmas De Gran Canaria,ES), E Caballero Dorta (Las Palmas De Gran Canaria,ES), M Lopez Perez (Las Palmas De Gran Canaria,ES), P Pena Ortega (Las Palmas De Gran Canaria,ES), D Rua-Figueroa Erausquin (Las Palmas De Gran Canaria,ES), J Medina Suarez (Las Palmas De Gran Canaria,ES), H Mendoza Lemes (Las Palmas De Gran Canaria,ES), M Blanco Nuez (Las Palmas De Gran Canaria,ES), A Cardenes Leon (Las Palmas De Gran Canaria,ES), A Garcia Quintana (Las Palmas De Gran Canaria,ES)

Authors:
M Galvan Ruiz1 , M Sanmamed Giron1 , M Singh1 , M Groba Marco1 , JJ Garcia Salvador1 , E Caballero Dorta1 , M Lopez Perez1 , P Pena Ortega1 , D Rua-Figueroa Erausquin1 , J Medina Suarez1 , H Mendoza Lemes1 , M Blanco Nuez2 , A Cardenes Leon1 , A Garcia Quintana1 , 1University Hospital of Gran Canaria Doctor Negrin - Las Palmas De Gran Canaria - Spain , 2University Hospital Insular of Gran Canaria - Las Palmas De Gran Canaria - Spain ,

On behalf: SAVE-RLife group

Citation:

Introduction: The mean age of patients included in the PARADIGM-HF trial was 63.8±11.5 years. Objective: To analyse the use, safety and efficacy of sacubitril-valsartan (SV) in different age groups.
Methods: This is an observational, ambispective study that included all patients with stable HFrEF who started SV between SEP2016 and DEC2018. The cohort was divided into three age groups: patients <65 years (y); 65 - 74 y and >75 y.
Results: 276 patients were included, 68 patients women (24,6%), 44.6% were <65 y (n=123); 29.3% between 65 - 74 y (n = 81) and 26.1% were > 75 y. The basal treatment was similar in all groups, except for a greater use of aldosterone antagonists in patients <65 y vs  >75 y (73% vs 56.9%, p=0.071). We observe in age group >75y a significant reduction in the estimated glomerular filtration rate (GFR) at baseline and after the use of SV (<65 y from 77.80 to 77.51 ml/min, 65 - 74 y from 66.39 to 60.72 ml/min >75 y from 61.28 to 56.74 ml/min, p<0.001), while the reduction of proBNP after using SV is independent of the age range (- 1316; - 1386; - 1492 pg/ml respectively; p=ns). A trend toward clinical improvement in NYHA class is present in all age groups (Figure 1).  LV remodeling,  defined as  LVEF increase and LV end-diastolic diameter (LVED) decrease after the use of SV, was observed in the three age groups, without any significant differences (+ 7.93, + 4.52, + 5.51 of increase in LVEF, p=ns; and - 2.37, - 2.58, - 0.16 of decrease in LVED, p=ns). There are no differences in adverse events between the different age groups (Table 1).
Conclusions: These results add data about the SV use in elderly patients. We show that SV is a safe and effective drug in this subgroup of patients. Despite a higher prevalence of comorbidities, an improvement in functional class without increasing side effects is observed.

N=276

Patients

< 65 años

N=123 (44.6%)

Patients

65 - 74 años

N=81 (29.3%)

Patients

≥ 75 años

N=72 (26.1%)

P value

Comorbidities

Ischemic cardiomyopathy, n (%)

61 (49.6%)

39 (48.1%)

43 (59.7%)

0.289

HBP n (%),

DM n (%),

AF n (%)

77 (62.6%),

49 (39.8%),

31 (25.2%)

64 (79%),

38 (46.9%),

35 (43.8%)

60 (83.3%),

38(52.8%),

33 (45.8%)

0.002,

0.203,

0.003

CRTn (%) / ICD n (%)

17 (13.8%) / 33 (26.8%)

11 (13.6%) / 11 (13.6%)

10 (13.9%) / 7 (9.7%)

0.660 /0.005

Adverse events

Acute renal failure, n (%)

19 (15.4%)

14 (17.5%)

12 (16.7%)

0.925

Symptom. Hypotension, n (%)

12 (9.8%)

8 (10%)

4 (5.6%)

0.536

Asympt. Hypotension, n (%)

12 (9.8%)

7 (8.8%)

8 (11.1%)

0.887

Hyperkaliemia, n (%)

14 (11.4%)

18 (22.5%)

10 (13.9%)

0.092

Hospital Admission/visit to the ER (mean± SD)

0.39± 1

0.38± 0.848

0.44± 0.963

0.893

Exitus

10 (8.1%)

6 (7.5%)

7 (9.7%)

0.878

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