LAUSR

Introduction Sacubitril-Valsartan combination (SVC) is new to the heart failure (HF) armamentarium. SVC, in addition to HF goal directed medical therapy (GDMT), is indicated to reduce the risk of cardiovascular (CV) death and HF hospitalizations in patients with reduced ejection fraction (HFrEF). PARADIGM-HF was stopped early due to overwhelming efficacy when compared to Enalapril. SVC dosed to the target 97/103 mg twice daily, reduced the primary composite outcomes of CV death or first HF hospitalization by 20%. HF guidelines recommend SVC as an option in patients with HFrEF. In PIONEER-HF, compared to Enalapril, SVC had a greater time-averaged reduction in NT-proBNP levels (25% vs. 47%, respectively) from baseline through weeks 4 and 8 after HF hospitalization. This combination was safe and well-tolerated in both studies. Hypothesis In PARADIGM-HF and PIONEER-HF the mean age was 62 years and the majority NYHA FC II to III. Results were difficult to extrapolate in patients >75 years with HFrEF. This group would be excluded from advanced therapies, i.e. cardiac transplant or durable mechanical circulatory support. HF GDMT optimization is the goal for this population. In clinical trials, SVC shows significant reduction in CV death and/or HF hospitalizations compared to Enalapril. We hypothesize that the clinical outcomes of patients >75 years with HFrEF receiving SVC would be favorable. Methods A retrospective chart review was conducted in a community hospital between January 2016 and December 2017. Subjects were identified via electronic health record. Inclusion criteria included age > 75 years, left ventricular ejection fraction < 40%, on maximally tolerated GDMT and SVC initiated during hospitalization. Subjects were excluded if SVC was not continued at discharge or lost to follow up. The clinical outcomes were CV death or first 30-day HF readmission, change in renal function or blood pressure. Descriptive statistics were used for data analysis. Results Inclusion criteria was met in 34 patients. Baseline characteristics: mean age 81 years, female 50%, mean weight 75 kg, BMI of 25, Caucasians 79% and mean ejection fraction 26%. Mean NT-ProBNP change from baseline was -68%. The first 30-day HF readmission was 14.7%. No patients were discharged on intravenous inotropes and no mortality reported. Conclusions SVC appears to lower first 30-day HF hospital readmissions in patients > 75 years old. It is well-tolerated among this population. Further, well-designed study was warranted.