Chronic Cardiac Insuficiency (CCI), is a very common pathology among elderly and the prognosis is particulary poor. Furthermore, there are considerable gaps between daily clinical practice and current guidelines-based recommendations for CCI therapy.

Our main goal was to replace in a classical association with beta blockers and aldosterone anagonists, CEI by sacubitril-valsartan (IRAN) and dapaglifozine (since 2020), for elderly patients (85 and over), with systolic dysfunction and CCI, once clinical results with classical treatments were disappointing.

We set up a prospective, observational, multicentric registry, starting January 2018: 357 patients when submission.

A titration allowed to obtain the highest dosage of ARNI clinically and biologically tolerated.

The following parameters were regularly collected:

– death from any cause;

– (re)hospitalization for acute heart failure;

– periodic assays for: serum potassium concentration, renal function, NTpro-BNP;

– Left Ventricular Ejection Fraction (LVEF) assessed by echocardiography;

– Blood Pressure (BP);

– Quality of Life (QOL).

Most patients dramatically improved their QOL, LVEF and NYHA classification level. Otherwise, we observed neither significative renal function impairment nor dyskalaemia, and the most common reversible adverse events were arterial hypotension and transient digestive disorders.

For elderly patients, there is a dramatic increase of rehospitalizations and death rates, especially after an acute heart failure episode. These results suggest that there is a strong evidence to switch classical CEI treatment with IRAN and Dapaglifozine, to complete a beta blockers/aldosterone antagonists therapy. IRAN and Dapaglifozine are a consistent and highly efficient alternative treatment for CCI, especially for elderly. QOL is dramatically improved, and this is probably the most important benefit we have to consider.