SPC365

Maximum dose sacubitril/valsartan in the elderly people with heart failure and reduced ejection fraction.

Session: Posters (Sessão 3 - Écran 4) - Insuficiência Cardíaca 3 - Terapêutica Farmacológica
Speaker: Eric Monteiro

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Eric Alberto Monteiro; José Barbosa; Joana Guimarães; Diogo Fernandes; Gonçalo Costa; Rita Gomes; João Rosa; Gustavo Campos; Sofia Martinho; Carolina Saleiro; José Almeida; Diana Campos; João Gameiro; André Azul; José Sousa; Cátia Ferreira; Susana Costa; Rui Baptista; Fátima Franco; Marta Madeira; Lino Gonçalves

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In the current ESC Guidelines, sacubitril/valsartan (SV) is recommended as a replacement for angiotensin-converting-enzyme inhibitors to reduce the risk of heart failure (HF) hospitalization and death. Nevertheless, HF elderly patients are underrepresented in SV HF trials. The aim of this study was to assess the effects of maximum dose SV (97/103mg twice daily) regarding its efficacy and safety in the elderly patients.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective analysis of 91 patients aged &ge;65 with heart failure and reduced ejection fraction (HFrEF) on maximum dose SV. &nbsp;Serum creatinine and potassium levels as well as systolic blood pressure (SBP) were evaluated at baseline and at 6 months follow-up to assess safety. NYHA class, NT-proBNP and left ventricular ejection fraction (LVEF) were evaluated at baseline and at 6 months follow-up to assess efficacy. Wilcoxon&#39;s Signed Rank test was used to test for statistically significant differences.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The median age was 70 [interquartile range (IQR) 67-76] and 82.4% were males. Ischaemic aetiology represented 46.6% of the cases. Regarding comorbidities, 44.4% had atrial fibrillation and 42.2% had diabetes. Beta-blockers and mineralocorticoid receptor antagonists were being used in 97.7 and 93% of the patients, respectively. At baseline, median serum creatinine was 1.13 mg/dL (IQR 0.90-1.49), median serum potassium was 4.4 mg/dL (IQR 4.1-4.9) and median SBP was 124 mmHg (IQR 117-136). Median baseline NYHA class was 2 (IQR 2-3), median NT-proBNP level was 855 mg/dL (IQR 493-2256) and median LVEF was 29% (IQR 23-35).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At 6 months follow-up, there was a significant improvement in NYHA class <span style="background-color:white">[median </span>2 (IQR 1-2) vs 2 (IQR 2-3); p&lt;0.001<span style="background-color:white">] and LVEF [median 38% (IQR 30-50) vs 29% (IQR 23-35); p=0.001]&nbsp;as well as a significant reduction in NT-proBNP levels [median 705 mg/dL (IQR 278-1836) vs 855 mg/dL (IQR 493-2256); p=0.017]. Regarding the safety parameters, no significant differences were observed in serum creatinine levels [median 1.29 mg/dL (IQR 0.96-1.75) vs 1.13 mg/dL (IQR 0.90-1.49); p=0.144]. There was a statistically significant rise in serum potassium levels [median 4.5 mg/dL (IQR 4.2-4.9) vs 4.4 mg/dL (IQR 4.1-4.9); p=0.020], but the magnitude of the rise wasn&acute;t clinically concerning. Systolic arterial pressure was significantly reduced [median 113 mmHg (IQR 99-127) vs 124 mmHg (IQR 117-136); p=0.001], but the final systolic arterial pressure was above the safety margin. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In this senior cohort of HFrEF patients treated with target dose of SV, there was a significant impact on NYHA class, NT-proBNP levels and LVEF. No significant differences were observed in serum creatinine levels. Despite verification of a significant increase in serum potassium and a significant decrease in SBP, these changes weren&acute;t strong enough to raise safety issues. We thereby conclude that SV on maximum dose is safe and effective in the elderly.</span></span></p>