Abstract: Objective To investigate the safety and effectiveness of the combination therapy of sacubitril/valsartan and cyclic adenosine monophosphate in the elderly patients with heart failure with reduced ejection fraction (HFrEF). Methods A prospective, randomized, controlled study was conducted. A total of 213 elderly patients with HFrEF admitted to Department of Cardiovascular Medicine, Jianhu Hospital Affiliated to Xinglin College of Nantong University from February 2021 to February 2023 were enrolled in this study and divided into experimental group (106 cases) and control group (107 cases)using the random number table method. The experimental group received the combined treatment of sacubitril/valsartan and cyclic adenosine monophosphate, while the control group received sacubitril/valsartan treatment.Both groups were treated for 14 d. The levels of left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), serum creatinine (SCr), aldosterone(ALD) and N-terminal pro-brain natriuretic peptide (NT-proBNP), New York Heart Association (NYHA) cardiac function classification and 6-minute walk distance(6MWD) were compared between the two groups before and after treatment. A 6-month follow-up was conducted, and the occurrences of heart failure readmission, all-cause death, and major adverse cardiovascular events (MACE) were recorded and compared between the two groups. Results Before treatment, there were no significant differences in the clinical data between the two groups (P>0.05). After treatment, the levels of LVEDD, LVESD, SCr, ALD and NT-proBNP were significantly decreased, and the levels of LVEF, eGFR and 6MWD were significantly increased in both groups, especially in the experimental group(P<0.05).The NYHA grade were improved in both groups, especially in the experimental group (P<0.05). Compared with the control group, the incidence rates of MACE, heart failure rehospitalization and all-cause mortality were significantly lower in the experimental group (P<0.05) during the follow-up period. Conclusions The combination therapy of sacubitril/valsartan and cyclic adenosine monophosphate can significantly improve the cardiac function and prognosis in the elderly patients with HFrEF, reduce all-cause mortality, heart failure readmission rate and MACE incidence, which is a safe and effective therapeutic option.

Key words: heart failure, sacubitril/valsartan, cyclic adenosine monophosphate, heart function, reduced ejection fraction