Impact of sacubitril-valsartan combined with ivabradine on prognosis of elderly patients with heart failure with preserved ejection fraction

Li Jianjun; Luo Changjiu; Wen Xin; Yi Bin

doi:10.3969/j.issn.1672-8157.2025.04.007

Abstract：Objective To observe the impact of angiotensin receptor-neprilysin inhibitor(ARNI)sacubitril-valsartan combined with ivabradine on prognosis of elderly patients with heart failure with preserved ejection fraction.Methods The clinical data were collected from 372 elderly patients with heart failure with preserved ejection fraction who were hospitalized in the Anyue County People's Hospital from December 2019 to December 2021 and were retrospectively analyzed.The enrolled patients were divided into the ARNI group(n=217)and the combination therapy group(n=155)according to different medication regimens.The patients in the ARNI group were treated with sacubitril-valsartan to their maximum tolerated individual dose,twice daily;the patients in the com-bination therapy group were given ivabradine 5 mg twice daily in addition to the ARNI regimen.Both groups received 12 months of treatment.The primary endpoint was major adverse cardiovascular events(MACE),including cardiovascular death and heart failure rehospitalization.Follow-up was conducted at 1,3,6,and 12 months after the start of treatment;MACEs,heart rate changes,blood pressure,adverse reactions and other clinical indicators were recorded.Results The incidence of MACEs of the combination the-rapy group was significantly lower than that of the ARNI group(11.61% vs 21.20% )(χ2=5.832,P=0.023),and the rate of heart failure rehospitalization of the combination therapy group was significantly lower than that of the ARNI group(7.74% vs 15.21% )(χ2=4.739,P=0.044).There was no significant difference in the cardiovascular mortality between the combination therapy group and the ARNI group(7.10% vs 11.06% )(χ2=1.666,P=0.267).The heart rate change value of the combination therapy group was significantly higher than that of the ARNI group[10.0(5.0,14.0)vs 3.0(2.0,4.0)](Z=-12.568,P<0.001).Cox proportional hazards regression analy-sis showed that the combined drug therapy with adjusted confounding factors was significantly associated with the reduced risk of MACEs(HR=0.57,95% CI:0.32-0.98,P=0.042).Conclusion In elderly patients with heart failure with preserved ejection frac-tion,sacubitril-valsartan combined with ivabradine can significantly reduce the incidence of MACEs,decrease the rehospitalization rate,and improve the prognosis of the patients.