Abstract: Objective To evaluate the safety and efficacy of sacubitril/valsartan in the elderly patients with heart failure with reduced ejection fraction(HFrEF). Methods A total of 215 elderly patients with HFrEF treated with either sacubitril/valsartan(ARNI group, n=110) or angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB)(control group, n=105) from September 2017 to September 2019 in our hospital were enrolled in the single-center observational cohort study. The indexes of echocardiography 6 months after treatment and the re-hospitalization rate due to heart failure within 1 year were compared between the two groups. Results After 6 months of treatment, the levels of left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left atrial diameter (LAD), and the beats of premature ventricular contractions (PVCs) in the two groups were significantly decreased, while the level of left ventricular ejection fraction (LVEF) was significantly increased (P<0.05). The level of LVEF in ARNI group was significantly higher than that in the control group (P<0.05). The rate of readmission due to heart failure within 1 year was lower in ARNI group than that in the control group (29.1% vs 54.3%, P<0.05). After adjusting age, sex, body mass index, atrial fibrillation, hypertension and other factors, Logistic regression analysis showed that the risk of re-hospitalization due to heart failure within 1 year in the patients using ARNI was only 0.23 times of that in the patients using ACEI/ARB (P=0.008). No severe adverse event was recorded. Conclusions Low dose sacubitril/valsartan can induce beneficial cardiac reverse remodeling and improve ventricular systolic and diastolic function in the elderly patients with HFrEF without severe adverse effect.

Key words: sacubitril/valsartan, heart failure with reduced ejection fraction, ventricular remodeling, readmission