Clinical efficacy and biological variations with sacubitril-valsartan prescription in the elderly a 2 years follow-up registry of 260 patients over the age of 80 with chronic heart failure - 25/12/18
, M. Cournot 2, A. Pathak 3, M. Galinier 4Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Résumé |
Background |
Chronic Cardiac Insufficiency (CCI) is a very common pathology among elderly and the prognosis is particularly poor.
Furthermore, there are considerable gaps between daily clinical practice and current guidelines-based recommendations for CCI therapy.
Despite this evidence, few studies have evaluated the pertinence and efficacy of medical therapies for these patients.
Purpose |
Our main goal was to replace in a classical association with beta blockers and aldosterone antagonists, converting enzymatic inhibitors or angiotensin receptors antagonists by sacubitril-valsartan for patients with systolic dysfunction and CCI, once the clinical results were disappointing.
Methods |
We set up a prospective observational multicentric registry, starting in january 2016, always running.
Four hundred and twenty patients are now included, most of them older than 80 (263: 62,6%), 188 (44,7%) are over 85, and 74 (17,6%) over 90. A titration allowed to obtain the highest dosage level of sacubitril-valsartan clinically tolerated, for each patient.
The following parameters were regularly collected:
– death from any cause;
– (re)hospitalisation for acute heart failure;
– periodic assays for: Serum potassium concentration, renal function, NTpro-BNP;
– left Ventricular ejection fraction (LVEF) by echocardiography;
– blood pressure;
– quality of life (QOL).
Results |
Most patients, in all age subgroups, dramatically improved their QOL and NYHA classification level.
LVEF quickly and significatively improved for a majority of patients.
Otherwise we didn’t observe significative renal dysfunction or dyskaliaemia, and the most common adverses events were arterial hypotension and transient digestive disorders.
Conclusion |
Sacubitril-valsartan is a consistent and highly efficient alternative treatment especially for elderly, when classical therapies give disappointing results in CCI.
In addition, these positive results are remarkably observed in all age subgroups of our registry.
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Vol 11 - N° 1
P. 43-44 - janvier 2019 Retour au numéro
Article précédent
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