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