Heart failure & cardiomyopathiesSecondary analysis
Effect of Sacubitril/Valsartan in Heart Failure with Preserved Ejection Fraction Across the Age Spectrum in PARAGON-HF
- Secondary analysis of the PARAGON-HF randomised trial
- age-group subgroup analysis
Authors' conclusion
Older patients with HF with preserved ejection fraction had higher event rates than younger patients, more adverse events overall, and more hypotension when treated with sacubitril/valsartan; however, the treatment benefits of sacubitril/valsartan were retained in older patients.
Study context
- Population
- Patients ≥50 years with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) ≥45%echocardiograms in 1097
- Participants
- 4,796 patients
- Comparison
- Sacubitril/valsartan vs valsartan across age groups
- <65 yearsn = 825reference
- 65-74 yearsn = 1,772
- ≥75 yearsn = 2,199
- Primary endpoint
- Total HF hospitalizations and cardiovascular (CV) death
Primary result
Primary composite outcome by age
Adjusted relative risk
1.39
95% CI 1.21–1.61
≥75 years vs <65 years
aRR 1.39 (95% CI 1.21–1.61)
As reported in the abstract
- Age did not modify the effect of sacubitril/valsartan vs valsartan on the primary composite endpoint (overall or LVEF ≤57%)
- P for interaction = 0.79
Further findings
| Outcome | Estimate | |
|---|---|---|
| Total HF hospitalization | aRR 1.27 (95% CI 1.09–1.49) | |
| CV death | aHR 2.04 (95% CI 1.44–2.87) | |
| 0.20.5125Ratio (log scale) |
Echocardiographic features
- Older patients had smaller LV chamber sizes, higher LVEF and more abnormal diastolic function
Safety
Hypotension
- Older adults on sacubitril/valsartan more likely to develop hypotension vs valsartan
- P for interaction = 0.026
Original publication
Effect of Sacubitril/Valsartan in Heart Failure with Preserved Ejection Fraction Across the Age Spectrum in PARAGON-HF. Eur J Heart Fail. Published 15 December 2024. doi:10.1002/ejhf.3535
Summarised from the published abstract; every number is checked against it