Skip to main content
SpringerLink
Log in

Short term effect of sacubitril/valsartan on comprehensive geriatric assessment in chronic heart failure: a real life analysis

  • IM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

Sacubitril/Valsartan (Sac-Val) has improved clinical prognosis in patients affected by heart failure (HF) with reduced ejection fraction (HFrEF). Comorbidities have a crucial impact on clinical presentation and prognosis in HF patients. Cognitive impairment (CoI) and Depression are a very common comorbidity in patients with HF and is widely recognized as a specific determinant of chronic disability, and HF patients with poor physical functional performance in Short physical performance battery (SPPB) showed a worse prognosis. The aim of the present study was to evaluate the potential effects of Sac-Val on functional, humoral, and cognitive aspects, evaluated by performing comprehensive geriatric assessment (CGA), in a cohort of elderly HFrEF. We studied 61 patients (51 men and 10 women, mean age 76.4 ± 5.1 years) suffering from HFrEF. After 6 months follow-up, we observed a significant improvement in humoral and functional parameters of CGA, renal function, NTpro-BNP levels and echocardiographic parameters. In the whole population, multivariate analysis shows that changes of Cardiac Index, NT-proBNP and Respiratory rate contributed for 26.0%, 9.7% and 4.8% to GDS variability, respectively, and the whole model accounted for a 41.1% of GDS variation; moreover changes of Global longitudinal strain, estimated glomerular filtration rate, Cardiac Index and BMI contributed for 23.9%, 11.7%, 5.4% and 4.0% to SPPB variability, respectively, and the whole model accounted for a 45% of SPPB variation. This represents the first real-world study carried out in an elderly population suffering from chronic HFrEF with numerous comorbidities, in which treatment with Sac-Val for 6 months induced important improvements in clinical, humoral, hemodynamic, and functional outcomes, without adverse effects on cognitive performance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Not applicable.

Code availability

Not available.

References

  1. de Frutos F, Mirabet S, Ortega-Paz L, Buera I, Darnés S, Farré N, Perez B, Adeliño R, Bascompte R, Pérez-Rodón J, Aparicio X, Sutil-Vega M, Soto A et al (2020) Management of heart failure with reduced ejection fraction after ESC 2016 heart failure guidelines: the Linx registry. ESC Heart Fail. https://doi.org/10.1002/ehf2.12567

    Article  Google Scholar 

  2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VK, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P et al (2016) ESC guidelines for the diagnosis treatment of acute chronic heart failure: the task force for the diagnosis treatment of acute chronic heart failure of the European society of cardiology (ESC). developed with the special contribution of the heart failure association (HFA) of the ESC. Eur J Heart Fail 18:891–975. https://doi.org/10.1002/ejhf.592

    Article  Google Scholar 

  3. Rich MW (2003) Drug therapy of heart failure in the elderly. Am J Geriatr Cardiol 12:235–242. https://doi.org/10.1111/j.1076-7460.2003.02013.x

    Article  Google Scholar 

  4. Jersey C, Kumar D, Yongfei W, Harlan MK (2013) National trends in heart failure hospital stay rates, 2001 to 2009. J Am Coll Cardiolo 61(10):1778–1788. https://doi.org/10.1016/j.jacc.2012.11.057

    Article  Google Scholar 

  5. Gale SE, Mardis A, Plazak ME, Kukin A, Reed BN (2021) Management of noncardiovascular comorbidities in patients with heart failure with reduced ejection fraction. Pharmacotherapy 41(6):537–545. https://doi.org/10.1002/phar.2528

    Article  Google Scholar 

  6. Yang M, Sun D, Wang Y, Yan M, Zheng J, Ren J (2022) Cognitive impairment in heart failure: landscape, challenges, and future directions. Front Cardiovasc Med 7(8):831734. https://doi.org/10.3389/fcvm.2021.831734

    Article  CAS  Google Scholar 

  7. Zuccalà G, Marzetti E, Cesari M, Lo Monaco MR, Antonica L, Cocchi A, Carbonin P, Bernabei R (2005) Correlates of cognitive impairment among patients with heart failure: results of a multicenter survey. Am J Med 118(5):496–502. https://doi.org/10.1016/j.amjmed.2005.01.030

    Article  Google Scholar 

  8. Hammond CA, Blades NJ, Chaudhry SI, Dodson JA, Longstreth WT Jr, Heckbert SR (2018) Long-term cognitive decline after newly diagnosed heart failure: longitudinal analysis in the CHS (cardiovascular health study). Circ Heart Fail 11(3):e004476. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004476

    Article  Google Scholar 

  9. Sciacqua A, Succurro E, Armentaro G, Miceli S, Pastori D, Rengo G, Sesti G (2021) Pharmacological treatment of type 2 diabetes in elderly patients with heart failure: randomized trials and beyond. Heart Fail Rev. https://doi.org/10.1007/s10741-021-10182-x

    Article  Google Scholar 

  10. Wedegärtner SM, Böhm M, Kindermann I (2020) Cognitive dysfunction in heart failure-causes and sequelae article in German. Internist (Berl) 61(9):929–938. https://doi.org/10.1007/s00108-020-00835-8

    Article  Google Scholar 

  11. Nordlund A, Berggren J, Holmstrom A, Fu M, Wallin A (2015) Frequent mild cognitive deficits in several functional domains in elderly patients with heart failure without known cognitive disorders. J Card Fail 21(9):702–707. https://doi.org/10.1016/j.cardfail.2015.04.006

    Article  Google Scholar 

  12. Vogels RL, Scheltens P, Schroeder-Tanka JM, Weinstein HC (2007) Cognitive impairment in heart failure: a systematic review of the literature. Eur J Heart Fail 9:440e9. https://doi.org/10.1016/j.ejheart.2006.11.001

    Article  Google Scholar 

  13. Gallagher R, Sullivan A, Burke R, Hales S, Gillies G, Cameron J, Saliba B, Tofler G (2013) Mild cognitive impairment, screening, and patient perceptions in heart failure patients. J Card Fail 19:641e6. https://doi.org/10.1016/j.cardfail.2013.08.001

    Article  Google Scholar 

  14. Hajduk AM, Lemon SC, McManus DD, Lessard DM, Gurwitz JH, Spencer FA, Goldberg RJ, Saczynski JS (2013) Cognitive impairment and self-care in heart failure. Clin Epidemiol 5:4071e6. https://doi.org/10.2147/CLEP.S44560

    Article  Google Scholar 

  15. Vogels RLC, Oosterman JM, Harten BV, Scheltens P, Flier WM, Schroeder-Tanka JM, Weinstein HC (2007) Profile of cognitive impairment in chronic heart failure. J Am Geriatr Soc 55(11):1764–1770. https://doi.org/10.1111/j.1532-5415.2007.01395.x (Epub 2007 Aug 28)

    Article  Google Scholar 

  16. Dolansky MA, Hawkins MAW, Schaefer JT, Sattar A, Gunstad J, Redle JD, Josephson R, Moore SM, Hughes JW (2016) The association between poorer cognitive function and reduced objectively monitored medication adherence in patients with heart failure. Circ Heart Fail 9(12):e002475. https://doi.org/10.1161/CIRCHEARTFAILURE.116.002475

    Article  CAS  Google Scholar 

  17. Masoudi FA, Baillie CA, Wang Y, Bradford WD, Steiner JF, Havranek EP, Foody JM, Krumholz HM (2005) The complexity and cost of drug regimens of older patients hospitalized with heart failure in the United States, 1998–2001. Arch Intern Med 165:2069–2076 ([PubMed: 16216996])

    Article  Google Scholar 

  18. Zuccala G, Pedone C, Cesari M, Onder G, Pahor M, Marzetti E, Lo Monaco MR, Cocchi A, Carbonin P, Bernabei R (2003) The effects of cognitive impairment on mortality among hospitalized patients with heart failure. Am J Med 115(2):97–103. https://doi.org/10.1016/s0002-9343(03)00264-x

    Article  Google Scholar 

  19. Sila CA (2007) Cognitive impairment in chronic heart failure. Cleve Clin J Med 74(Suppl 1):S132e7

    Google Scholar 

  20. Cameron J, Worrall-Carter L, Page K, Riegel B, Lo SK, Stewart S (2010) Does cognitive impairment predict poor self-care in patients with heart failure? Eur J Heart Fail 12:508e15. https://doi.org/10.1093/eurjhf/hfq042 (Epub 2010 Mar 30)

    Article  Google Scholar 

  21. Angermann E, George E (2018) Depression, anxiety, and cognitive impairment. Curr Heart Fail Rep. https://doi.org/10.1007/s11897-018-0414-8

    Article  Google Scholar 

  22. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ (2006) Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol 48:1527–1537. https://doi.org/10.1016/j.jacc.2006.06.055

    Article  Google Scholar 

  23. Konstam V, Moser DK, De Jong MJ (2005) Depression and anxiety in heart failure. J Card Fail 11:455–463. https://doi.org/10.1016/j.cardfail.2005.03.006

    Article  Google Scholar 

  24. Vaccarino V, Kasl SV, Abramson J, Krumholz HM (2001) Depressive symptoms and risk of functional decline and death in patients with heart failure. J Am Coll Cardiol 38:199–205. https://doi.org/10.1016/s0735-1097(01)01334-1

    Article  CAS  Google Scholar 

  25. Dekker RL, Lennie TA, Doering LV, Chung ML, Wu JR, Moser DK (2014) Coexisting anxiety and depressive symptoms in patients with heart failure. Eur J Cardiovasc Nurs 13:168–176. https://doi.org/10.1177/1474515113519520 (Epub 2014 Jan 9)

    Article  Google Scholar 

  26. Rodríguez-Pascual C, Vilches-Moraga A, Paredes-Galán E, Ferrero-Marinez AI, Torrente-Carballido M, Rodríguez-Artalejo F (2012) Comprehensive geriatric assessment and hospital mortality among older adults with decompensated heart failure. Am Heart J 164(5):756–762. https://doi.org/10.1016/j.ahj.2012.08.009 (Epub 2012 Oct 16)

    Article  Google Scholar 

  27. Rodríguez-Pascual C, Paredes-Galan E, Vilches-Moraga A, Ferrero-Marinez AI, Torrente-Carballido M, Rodríguez-Artalejo F (2014) Comprehensive geriatric assessment and 2 year mortality in elderly patients hospitalized for heart failure. Circ Cardiovasc Qual Outcomes 7(2):251–258. https://doi.org/10.1161/CIRCOUTCOMES.113.000551 (Epub 2014 Mar 4)

    Article  Google Scholar 

  28. McMurray JJV, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR et al (2014) Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371:993–1004. https://doi.org/10.1056/NEJMoa1409077

    Article  CAS  Google Scholar 

  29. Armentaro G, D’Arrigo G, Magurno M, Toscani AF, Condoleo V, Miceli S et al (2021) Impact of Sacubitril/Valsartan on clinical and echocardiographic parameters in heart failure patients with reduced ejection fraction: data from a real life 2 year follow-up study. Front Pharmacol 12:733475. https://doi.org/10.3389/fphar.2021.733475

    Article  CAS  Google Scholar 

  30. Pelaia C, Armentaro G, Volpentesta M, Mancuso L, Miceli S, Caroleo B et al (2022) Effects of sacubitril-valsartan on clinical, echocardiographic, and polygraphic parameters in patients affected by heart failure with reduced ejection fraction and sleep apnea. Front Cardiovasc Med 9:861663. https://doi.org/10.3389/fcvm.2022.861663.eCollection2022

    Article  CAS  Google Scholar 

  31. Armentaro G, D’Arrigo G, Miceli S, Cassano V, Perticone M, Maio R et al (2022) Long term metabolic effects of sacubitril/valsartan in non-diabetic and diabetic patients with heart failure reduced ejection fraction: a real life study. Frontiers in Physiology. Front Physiol 13:897109. https://doi.org/10.3389/fphys.2022.897109

    Article  Google Scholar 

  32. Cannon JA, Shen L, Jhund PS, Kristensen SL, Kober L, Chen F et al (2017) Dementia-related adverse events in PARADIGM-HF and other trials in heart failure with reduced ejection fraction. Eur J Heart Fail 19(1):129–137. https://doi.org/10.1002/ejhf.687 (Epub 2016 Nov 20)

    Article  CAS  Google Scholar 

  33. De Vecchis R, Ariano C, Di Biase G, Noutsias M (2019) Cognitive performance of patients with chronic heart failure on Sacubitril/Valsartan. A Retrosp Cohort Stud Herz 44(6):534–540. https://doi.org/10.1007/s00059-018-4683-5 (Epub 2018 Feb 15)

    Article  Google Scholar 

  34. Galo J, Celli D, Colombo R (2020) Effect of Sacubitril/Valsartan on neurocognitive function: current status and future directions. Am J Cardiovasc Drug 21(3):267–270. https://doi.org/10.1007/s40256-020-00445-7 (Epub 2020 Oct 16)

    Article  CAS  Google Scholar 

  35. Cacciatore F, Amarelli C, Maiello C, Pratillo M, Tosini P, Mattucci I, Salerno G, Curcio F, Elia F, Mercurio V, Golino P, Bonaduce D, Abete P (2020) Effect of Sacubitril-Valsartan in reducing depression in patients with advanced heart failure. J Affect Disord 272:132–137. https://doi.org/10.1016/j.jad.2020.03.158

    Article  Google Scholar 

  36. Dereli S, Kılınçel O, Çerik IB, Kaya A (2020) Impact of Sacubitril/Valsartan treatment on depression and anxiety in heart failure with reduced ejection fraction. Acta Cardiol 75(8):774–782. https://doi.org/10.1080/00015385.2020.1730577 (Epub 2020 Mar 18)

    Article  Google Scholar 

  37. American Diabetes Association (2019) 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care 42:S13–S28. https://doi.org/10.2337/dc19-S002

    Article  Google Scholar 

  38. Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R et al (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry task force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 16(1):1–11. https://doi.org/10.1093/ehjci/jeu184 (Epub 2014 Dec 18)

    Article  CAS  Google Scholar 

  39. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I et al (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458. https://doi.org/10.1016/0002-9149(86)90771-x

    Article  CAS  Google Scholar 

  40. Kalam K, Otahal P, Marwick TH (2014) Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 100(21):1673–1680. https://doi.org/10.1136/heartjnl-2014-305538

    Article  Google Scholar 

  41. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612. https://doi.org/10.7326/0003-4819-150-9-200905050-00006

    Article  Google Scholar 

  42. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state” a practical method for gradingthe cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198. https://doi.org/10.1016/0022-3956(75)90026-6

    Article  CAS  Google Scholar 

  43. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies Of illness In the aged the index of Adl: a standardized measure of biological and psychosocial function. JAMA 185:914–919. https://doi.org/10.1001/jama.1963.03060120024016

    Article  CAS  Google Scholar 

  44. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontolo 9:179–186

    Article  CAS  Google Scholar 

  45. Parmalee PA, Thuras PD, Katz IR, Lawton MP (1995) Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatr Soc 43:130–213. https://doi.org/10.1111/j.1532-5415.1995.tb06377.x

    Article  Google Scholar 

  46. Yesavage JA, Rose TL, Lum O, Huang V, Adey M, Leirer VO (1983) Development and validation of geriatric depression screening: a preliminary report. J Psychiatr Res 17:37–49. https://doi.org/10.1016/0022-3956(82)90033-4

    Article  CAS  Google Scholar 

  47. Freire AN, Guerra RO, Alvarado B, Guralnik JM, Zunzunegui MV (2012) Validity and reliability of the short physical performance battery in two diverse older adult populations in Quebec and Brazil. J Aging Health. https://doi.org/10.1177/0898264312438551

    Article  Google Scholar 

  48. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M et al (2021) 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42(36):3599–3726. https://doi.org/10.1093/eurheartj/ehab368

    Article  CAS  Google Scholar 

  49. Cassano V, Crescibene D, Hribal ML, Pelaia C, Armentaro G, Magurno M et al (2020) Uric acid and vascular damage in essential hypertension: role of insulin resistance. Nutrients 12(9):2509. https://doi.org/10.3390/nu12092509

    Article  CAS  Google Scholar 

  50. Pelaia C, Pastori D, Armentaro G, Miceli S, Cassano V, Barbara K et al (2021) Predictors of renal function worsening in patients with chronic obstructive pulmonary disease (COPD): a multicenter observational study. Nutrients 13(8):2811. https://doi.org/10.3390/nu13082811

    Article  CAS  Google Scholar 

  51. Cannon JA, McMurray JJ, Quinn TJ (2015) ‘Hearts and minds’: association, causation and implication of cognitive impairment in heart failure. Alzheimers Res Ther. https://doi.org/10.1186/s13195-015-0106-5

    Article  Google Scholar 

  52. Valenti R, Pantoni L, Markus HS (2014) Treatment of vascular risk factors in patients with a diagnosis of Alzheimer’s disease: a systematic review. BMC Med 12:160. https://doi.org/10.1186/s12916-014-0160-z

    Article  Google Scholar 

  53. Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes NC, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico A et al (2013) BRAIN-ICU study investigators long-term cognitive impairment after critical illness. N Engl J Med 369:1306–1316. https://doi.org/10.1056/NEJMoa1301372

    Article  CAS  Google Scholar 

  54. Cannon JA, Moffitt P, Perez-Moreno AC, Walters MR, Broomfield NM, McMurray JJV, Quinn TJ (2017) Cognitive impairment and heart failure: systematic review and meta-analysis. J Card Fail 23(6):464–475. https://doi.org/10.1016/j.cardfail.2017.04.007

    Article  Google Scholar 

  55. Cannon JA, Shen L, Jhund PS, Kristensen SL, Køber L, Chen F, Gong J, Lefkowitz MP, Rouleau JL, Shi VC, Swedberg K, Zile MR, Solomon SD et al (2017) Dementia-related adverse events in PARADIGM-HF and other trials in heart failure with reduced ejection fraction. Eur J Heart Fail 19:129–137. https://doi.org/10.1002/ejhf.687

    Article  CAS  Google Scholar 

  56. Langenickel TH, Tsubouchi C, Ayalasomayajula S, Pal P, Valentin MA, Hinder M, Jhee S, Gevorkyan H, Rajman I (2016) The effect of LCZ696 (Sacubitril/Valsartan) on amyloid-β concentrations in cerebrospinal fluid in healthy subjects. Br J Clin Pharmacol 81:878–890. https://doi.org/10.1111/bcp.12861 (Epub 2016 Mar 8)

    Article  CAS  Google Scholar 

  57. Fuentes-Abolafio IJ, Stubbs B, Pérez-Belmonte LM, Bernal-López MR, Gómez-Huelgas R, Cuesta-Vargas AI (2020) Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis. BMC Cardiovasc Disord 20(1):512. https://doi.org/10.1186/s12872-020-01725-5

    Article  Google Scholar 

  58. Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR et al (2021) Physical rehabilitation for older patients hospitalized for heart failure. N Engl J Med 385(3):203–216. https://doi.org/10.1056/NEJMoa2026141 (Epub 2021 May 16)

    Article  Google Scholar 

  59. Warraich HJ, Kitzman DW, Whellan DJ, Duncan PW, Mentz RJ, Pastva AM et al (2018) Physical function, frailty, cognition, depression, and quality of life in hospitalized adults ≥60 Years with acute decompensated heart failure with preserved versus reduced ejection fraction. Circ Heart Fail 11(11):e005254. https://doi.org/10.1161/CIRCHEARTFAILURE.118.005254

    Article  Google Scholar 

Download references

Funding

None.

Author information

Author notes

  1. Giuseppe Armentaro and Valentino Condoleo have contributed equally.

Authors and Affiliations

  1. Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy

    Giuseppe Armentaro, Valentino Condoleo, Corrado Pelaia, Velia Cassano, Sofia Miceli, Raffaele Maio, Maria Chiara Pelle, Maria Perticone, Elena Succurro, Franco Arturi, Francesco Andreozzi & Angela Sciacqua

  2. IRCSS SYNLAB SDN, Diagnostic and Nuclear Institute, Naples, Italy

    Andrea Salzano

  3. Department of Clinical and Molecular Medicine, University Rome-Sapienza, Rome, Italy

    Giorgio Sesti

Authors
  1. Giuseppe Armentaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valentino Condoleo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Corrado Pelaia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Velia Cassano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sofia Miceli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raffaele Maio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrea Salzano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Chiara Pelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maria Perticone
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Elena Succurro
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Franco Arturi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Francesco Andreozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Giorgio Sesti
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Angela Sciacqua
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization AS, GA, VC, CP, VC, SM, RM, AS, MCP, MP, ES, FA, FA, GS methodology, GA, SM, AS; statistical analysis GA; validation AS, MCP, MP, ES, FA, FA, GS, AS; writing-original draft preparation GA, VC , AS; writing-review and editing GA, VC, GS, AS; visualization AS, GA, VC, CP, VC, SM, RM, AS, MCP, MP, ES, FA, FA, GS supervision, AS; project administration, AS All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Angela Sciacqua.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

The local Ethical Committee (Comitato etico Regione Calabria “Area Centro”) approved the protocol (code protocol number 2012.63). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

Informed written consent was obtained from all participants.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Armentaro, G., Condoleo, V., Pelaia, C. et al. Short term effect of sacubitril/valsartan on comprehensive geriatric assessment in chronic heart failure: a real life analysis. Intern Emerg Med 18, 113–125 (2023). https://doi.org/10.1007/s11739-022-03130-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-022-03130-6

Keywords

Search

Navigation