Roca Luis Nieto, García Marcelino Cortés, Germán Jorge Balaguer, Becerra Antonio José Bollas, Otero José María Romero, Chapel José Antonio Esteban, López Carlos Rodríguez, Lázaro Ana María Pello, Urquía Mikel Taibo, Tuñón José
Cardiology Department, Son Espases University Hospital, 07120 Balearic Islands, Spain.
Cardiology Department, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain.
J Clin Med. 2024 Aug 14;13(16):4772. doi: 10.3390/jcm13164772.
Heart failure (HF) is a highly prevalent syndrome in elderly subjects. Currently, multiple drugs have shown clinical benefits in patients with HF and reduced ejection fraction (HFrEF). However, evidence is scarce in elderly patients (beyond 75 years old), even more so for the latest drugs, such as angiotensin receptor-neprilysin inhibitors (ARNIs). This study aims to evaluate the use and benefits of ARNIs in elderly patients with HFrEF. : A prospective observational cohort study was designed. Patients with left ventricular systolic dysfunction (defined by left ventricular ejection fraction [LVEF] < 40%) and age ≥ 75 years from January 2016 to December 2020 were prospectively included. Patients with an indication for ARNIs at inclusion or throughout follow-up were selected. Clinical, electrocardiographic and echocardiographic variables were collected. : A total of 616 patients were included, 34.4% of them female, with a mean age of 83.3 years, mean LVEF of 28.5% and ischemic etiology in 53.9% of patients. Only 14.3% of patients were taking ARNIs. After a mean follow-up of 34 months, 50.2% of patients died, and 62.2% had a cardiac event (total mortality or hospital admission due to HF). Multivariate Cox regression analysis showed that the use of ARNIs was independently and significantly associated with lower rates of mortality [HR 0.36 (95% CI 0.21-0.61)], with similar results in relation to all-cause mortality in a propensity-score-matched analysis [HR 0.33 (95% CI 0.19-0.57)]. : We observed an important underuse of ARNIs in a cohort of elderly HFrEF patients, in which treatment with ARNIs was associated with a significant reduction in mortality. Greater implementation of clinical practice guidelines in this group of patients could improve their prognosis.
心力衰竭（HF）在老年人群中是一种高度流行的综合征。目前，多种药物已在射血分数降低的心力衰竭（HFrEF）患者中显示出临床益处。然而，老年患者（75岁以上）的相关证据很少，对于最新的药物，如血管紧张素受体脑啡肽酶抑制剂（ARNI）更是如此。本研究旨在评估ARNI在老年HFrEF患者中的使用情况和益处。：设计了一项前瞻性观察性队列研究。前瞻性纳入2016年1月至2020年12月期间左心室收缩功能障碍（定义为左心室射血分数[LVEF]<40%）且年龄≥75岁的患者。选择纳入时或整个随访期间有ARNI使用指征的患者。收集临床、心电图和超声心动图变量。：共纳入616例患者，其中34.4%为女性，平均年龄83.3岁，平均LVEF为28.5%，53.9%的患者有缺血性病因。只有14.3%的患者正在服用ARNI。平均随访34个月后，50.2%的患者死亡，62.2%的患者发生心脏事件（全因死亡或因HF住院）。多变量Cox回归分析显示，使用ARNI与较低的死亡率独立且显著相关[风险比（HR）0.36（95%置信区间0.21-0.61）]，倾向评分匹配分析中全因死亡率的结果相似[HR 0.33（95%置信区间0.19-0.57）]。：我们观察到在老年HFrEF患者队列中ARNI的使用严重不足，其中ARNI治疗与死亡率显著降低相关。在这组患者中更广泛地实施临床实践指南可以改善他们的预后。
