Benefits of Sacubitril/Valsartan in Frail Older Hospitalised Patients

Background
Frailty is associated with worse clinical outcomes in heart failure (HF) patients [1]. The benefits of sacubitril/valsartan in frail HF patients are unclear [2]. This study explored whether use of sacubitril/valsartan leads to improved clinical outcomes in frail hospitalised HF patients.

Methods
This cross-sectional multicentre study included all HF admissions over a period of 7 years at two tertiary hospitals in Australia. Frailty status was determined by use of the Hospital Frailty Risk Score (HFRS) [3] and patients with a score of ≥5 were classified as frail. The primary outcome for this study was the days-alive-and-out-of-hospital at 90 days of hospital discharge (DAOH90). Multilevel multivariable Poisson regression model determined whether frail patients who were on sacubitril/valsartan had increased DAOH90 after adjustment for age, sex, Charlson index (CCI), creatinine, brain natriuretic peptide (BNP), haemoglobin, albumin, C-reactive protein (CRP), and use of other heart failure-specific medications.

Results
There were 5,734 HF admissions during the study period and 1,406 (24.5%) were classified as frail, of whom 22 (1.6%) patients were on sacubitril/valsartan. Frail patients who were on sacubitril/valsartan were significantly younger, with a higher CCI and lower creatinine levels than those who were not on this treatment (p<0.05). The mean (SD) DAOH90 was significantly increased in frail patients who were on sacubitril/valsartan than those who were not on this treatment (84.6 (16.5) vs 61.7 (36.6) days, respectively). After adjusted analysis frail patients on sacubitril/valsartan were 22% more likely to have an increased DAOH90 than those without this treatment (IRR 1.22, 95% CI 1.16–1.29, p<0.001).

Conclusion
Use of sacubitril/valsartan is associated with improved clinical outcomes in frail HF patients.