老年人的耐受性，年轻人的持续性：亚洲心力衰竭队列中沙库巴曲缬沙坦跨年龄的真实世界证据。
Tolerability for older, persistence for younger: a real-world evidence on sacubitril/valsartan in an Asian heart failure cohort across age.
作者信息
Chan Po-Kai, Hsu Chu-Yu, Lee Chao-Chin, Yu Fan-Han, Chung Fa-Po, Liao Chia-Te, Huang Jin-Long, Liang Huai-Wen, Lee Ying-Hsiang, Lin Po-Lin, Chiou Wei-Ru, Hsu Chien-Yi, Chang Hung-Yu, Lin Wen-Yu
机构信息
School of Medicine, National Defense Medical Center, Taipei, Taiwan.
Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
出版信息
Front Cardiovasc Med. 2025 Jul 22;12:1620266. doi: 10.3389/fcvm.2025.1620266. eCollection 2025.
BACKGROUND
Sacubitril/Valsartan (S/V) benefits patients with heart failure with reduced ejection fraction (HFrEF), but its tolerability and clinical outcomes across age groups, especially the elderly, remain unclear. This real-world study evaluates these factors in an Asian cohort.
METHODS
This retrospective cohort study analyzed data from the Treatment with Angiotensin Receptor Neprilysin Inhibitor for Taiwan Heart Failure Patients (TAROT-HF) registry (2017-2018). Patients were stratified into three age groups: <65, 65-74, and ≥75 years. Tolerability was defined as achieving at least 50% of the target S/V dosage (200 mg/day). Baseline characteristics, treatment doses, and clinical outcomes-including the composite of first unplanned heart failure hospitalization (HFH) or cardiovascular (CV) death, all-cause mortality, CV death, and HFH-were assessed over 5 years.
RESULTS
Among 1,987 patients, older adults had more comorbidities and received lower S/V doses. Achieving tolerability significantly reduced composite outcome risk in patients <65 (HR = 0.40, 95% CI: 0.27-0.59, < 0.001), all-cause mortality (HR = 0.30, < 0.001), CV death (HR = 0.41, 95% CI: 0.21-0.80, = 0.009), and HFH (HR = 0.41, 95% CI: 0.27-0.62, < 0.001). Those aged 65-74 had similar benefits except for CV death. In patients ≥75, reaching tolerability improved composite outcome (HR = 0.60, 95% CI: 0.39-0.91, = 0.017) and HFH (HR = 0.60, 95% CI: 0.38-0.95, = 0.029). Partial dosing still provided protection in younger patients.
CONCLUSION
S/V improves HFrEF clinical outcomes across age groups in an Asian population, especially when achieving tolerability, defined as reaching ≥50% of the target dose. While this association was less pronounced in older patients, our result suggested that individualized dosing strategies should prioritize persistence in younger patients while accommodating tolerability in older populations.
背景
沙库巴曲缬沙坦（S/V）对射血分数降低的心力衰竭（HFrEF）患者有益，但在不同年龄组，尤其是老年人中的耐受性和临床结局尚不清楚。这项真实世界研究在一个亚洲队列中评估了这些因素。
方法
这项回顾性队列研究分析了台湾心力衰竭患者血管紧张素受体脑啡肽酶抑制剂治疗（TAROT-HF）注册研究（2017-2018年）的数据。患者被分为三个年龄组：<65岁、65-74岁和≥75岁。耐受性定义为达到目标S/V剂量（200mg/天）的至少50%。在5年期间评估基线特征、治疗剂量和临床结局，包括首次非计划心力衰竭住院（HFH）或心血管（CV）死亡的复合结局、全因死亡率、CV死亡和HFH。
结果
在1987例患者中，老年人合并症更多，接受的S/V剂量更低。达到耐受性显著降低了<65岁患者的复合结局风险（HR = 0.40，95%CI：0.27-0.59，P < 0.001）、全因死亡率（HR = 0.30，P < 0.001）、CV死亡（HR = 0.41，95%CI：0.21-0.80，P = 0.009）和HFH（HR = 0.41，95%CI：0.27-0.62，P < 0.001）。65-74岁的患者除CV死亡外有类似的获益。在≥75岁的患者中，达到耐受性改善了复合结局（HR = 0.60，95%CI：0.39-0.91，P = 0.017）和HFH（HR = 0.60，95%CI：0.38-0.95，P = 0.029）。部分剂量对年轻患者仍有保护作用。
结论
在亚洲人群中，S/V改善了各年龄组的HFrEF临床结局，尤其是达到定义为达到目标剂量≥50%的耐受性时。虽然这种关联在老年患者中不太明显，但我们的结果表明，个体化给药策略应优先考虑年轻患者的持续性，同时兼顾老年人群的耐受性。
Zotero 插件