Tolerability for older, persistence for younger: a real-world evidence on sacubitril/valsartan in an Asian heart failure cohort across age
BackgroundSacubitril/Valsartan (S/V) benefits patients with heart failure with reduced ejection fraction (HFrEF), but its tolerability and clinical outcomes across age groups, especially the elderly, remain unclear. This real-world study evaluates these factors in an Asian cohort.MethodsThis retrosp...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1620266/full |
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| author | Po-Kai Chan Po-Kai Chan Chu-Yu Hsu Chao-Chin Lee Chao-Chin Lee Fan-Han Yu Fa-Po Chung Fa-Po Chung Chia-Te Liao Chia-Te Liao Jin-Long Huang Jin-Long Huang Huai-Wen Liang Ying-Hsiang Lee Ying-Hsiang Lee Ying-Hsiang Lee Po-Lin Lin Po-Lin Lin Po-Lin Lin Wei-Ru Chiou Wei-Ru Chiou Wei-Ru Chiou Chien-Yi Hsu Chien-Yi Hsu Hung-Yu Chang Wen-Yu Lin Wen-Yu Lin |
| author_facet | Po-Kai Chan Po-Kai Chan Chu-Yu Hsu Chao-Chin Lee Chao-Chin Lee Fan-Han Yu Fa-Po Chung Fa-Po Chung Chia-Te Liao Chia-Te Liao Jin-Long Huang Jin-Long Huang Huai-Wen Liang Ying-Hsiang Lee Ying-Hsiang Lee Ying-Hsiang Lee Po-Lin Lin Po-Lin Lin Po-Lin Lin Wei-Ru Chiou Wei-Ru Chiou Wei-Ru Chiou Chien-Yi Hsu Chien-Yi Hsu Hung-Yu Chang Wen-Yu Lin Wen-Yu Lin |
| author_sort | Po-Kai Chan |
| collection | DOAJ |
| description | BackgroundSacubitril/Valsartan (S/V) benefits patients with heart failure with reduced ejection fraction (HFrEF), but its tolerability and clinical outcomes across age groups, especially the elderly, remain unclear. This real-world study evaluates these factors in an Asian cohort.MethodsThis retrospective cohort study analyzed data from the Treatment with Angiotensin Receptor Neprilysin Inhibitor for Taiwan Heart Failure Patients (TAROT-HF) registry (2017–2018). Patients were stratified into three age groups: <65, 65–74, and ≥75 years. Tolerability was defined as achieving at least 50% of the target S/V dosage (200 mg/day). Baseline characteristics, treatment doses, and clinical outcomes—including the composite of first unplanned heart failure hospitalization (HFH) or cardiovascular (CV) death, all-cause mortality, CV death, and HFH—were assessed over 5 years.ResultsAmong 1,987 patients, older adults had more comorbidities and received lower S/V doses. Achieving tolerability significantly reduced composite outcome risk in patients <65 (HR = 0.40, 95% CI: 0.27–0.59, p < 0.001), all-cause mortality (HR = 0.30, p < 0.001), CV death (HR = 0.41, 95% CI: 0.21–0.80, p = 0.009), and HFH (HR = 0.41, 95% CI: 0.27–0.62, p < 0.001). Those aged 65–74 had similar benefits except for CV death. In patients ≥75, reaching tolerability improved composite outcome (HR = 0.60, 95% CI: 0.39–0.91, p = 0.017) and HFH (HR = 0.60, 95% CI: 0.38–0.95, p = 0.029). Partial dosing still provided protection in younger patients.ConclusionS/V improves HFrEF clinical outcomes across age groups in an Asian population, especially when achieving tolerability, defined as reaching ≥50% of the target dose. While this association was less pronounced in older patients, our result suggested that individualized dosing strategies should prioritize persistence in younger patients while accommodating tolerability in older populations. |
| format | Article |
| id | doaj-art-2d6199701b6540349dae988f7ab4d8b9 |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-2d6199701b6540349dae988f7ab4d8b92025-08-20T03:51:19ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-07-011210.3389/fcvm.2025.16202661620266Tolerability for older, persistence for younger: a real-world evidence on sacubitril/valsartan in an Asian heart failure cohort across agePo-Kai Chan0Po-Kai Chan1Chu-Yu Hsu2Chao-Chin Lee3Chao-Chin Lee4Fan-Han Yu5Fa-Po Chung6Fa-Po Chung7Chia-Te Liao8Chia-Te Liao9Jin-Long Huang10Jin-Long Huang11Huai-Wen Liang12Ying-Hsiang Lee13Ying-Hsiang Lee14Ying-Hsiang Lee15Po-Lin Lin16Po-Lin Lin17Po-Lin Lin18Wei-Ru Chiou19Wei-Ru Chiou20Wei-Ru Chiou21Chien-Yi Hsu22Chien-Yi Hsu23Hung-Yu Chang24Wen-Yu Lin25Wen-Yu Lin26School of Medicine, National Defense Medical Center, Taipei, TaiwanDivision of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Cardiology, Department of Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, TaiwanSchool of Medicine, National Defense Medical Center, Taipei, TaiwanDivision of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivsion of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanFaculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanDivsion of Cardiology, Chi-Mei Medical Center, Tainan, TaiwanDepartment of Public Health, College of Medicine, National Cheng Kung University, Tainan, TaiwanFaculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanCardiovascular Center, Taichung Veterans General Hospital, Taichung, TaiwanDivision of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan0Department of Medicine, MacKay Medical College, New Taipei City, Taiwan1Cardiovascular Medicine, MacKay Memorial Hospital, Taipei, Taiwan2Department of Artificial Intelligence and Medical Application, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan0Department of Medicine, MacKay Medical College, New Taipei City, Taiwan3Divsion of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan4Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan0Department of Medicine, MacKay Medical College, New Taipei City, Taiwan5Divsion of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung, Taiwan6College of Science and Engineering, National Taitung University, Taitung, Taiwan7Divsion of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan8Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan9Heart Center, Cheng Hsin General Hospital, Taipei, TaiwanSchool of Medicine, National Defense Medical Center, Taipei, TaiwanDivision of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanBackgroundSacubitril/Valsartan (S/V) benefits patients with heart failure with reduced ejection fraction (HFrEF), but its tolerability and clinical outcomes across age groups, especially the elderly, remain unclear. This real-world study evaluates these factors in an Asian cohort.MethodsThis retrospective cohort study analyzed data from the Treatment with Angiotensin Receptor Neprilysin Inhibitor for Taiwan Heart Failure Patients (TAROT-HF) registry (2017–2018). Patients were stratified into three age groups: <65, 65–74, and ≥75 years. Tolerability was defined as achieving at least 50% of the target S/V dosage (200 mg/day). Baseline characteristics, treatment doses, and clinical outcomes—including the composite of first unplanned heart failure hospitalization (HFH) or cardiovascular (CV) death, all-cause mortality, CV death, and HFH—were assessed over 5 years.ResultsAmong 1,987 patients, older adults had more comorbidities and received lower S/V doses. Achieving tolerability significantly reduced composite outcome risk in patients <65 (HR = 0.40, 95% CI: 0.27–0.59, p < 0.001), all-cause mortality (HR = 0.30, p < 0.001), CV death (HR = 0.41, 95% CI: 0.21–0.80, p = 0.009), and HFH (HR = 0.41, 95% CI: 0.27–0.62, p < 0.001). Those aged 65–74 had similar benefits except for CV death. In patients ≥75, reaching tolerability improved composite outcome (HR = 0.60, 95% CI: 0.39–0.91, p = 0.017) and HFH (HR = 0.60, 95% CI: 0.38–0.95, p = 0.029). Partial dosing still provided protection in younger patients.ConclusionS/V improves HFrEF clinical outcomes across age groups in an Asian population, especially when achieving tolerability, defined as reaching ≥50% of the target dose. While this association was less pronounced in older patients, our result suggested that individualized dosing strategies should prioritize persistence in younger patients while accommodating tolerability in older populations.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1620266/fullsacubitril/valsartanagetolerabilityheart failurereal-world studyolder patient |
| spellingShingle | Po-Kai Chan Po-Kai Chan Chu-Yu Hsu Chao-Chin Lee Chao-Chin Lee Fan-Han Yu Fa-Po Chung Fa-Po Chung Chia-Te Liao Chia-Te Liao Jin-Long Huang Jin-Long Huang Huai-Wen Liang Ying-Hsiang Lee Ying-Hsiang Lee Ying-Hsiang Lee Po-Lin Lin Po-Lin Lin Po-Lin Lin Wei-Ru Chiou Wei-Ru Chiou Wei-Ru Chiou Chien-Yi Hsu Chien-Yi Hsu Hung-Yu Chang Wen-Yu Lin Wen-Yu Lin Tolerability for older, persistence for younger: a real-world evidence on sacubitril/valsartan in an Asian heart failure cohort across age Frontiers in Cardiovascular Medicine sacubitril/valsartan age tolerability heart failure real-world study older patient |
| title | Tolerability for older, persistence for younger: a real-world evidence on sacubitril/valsartan in an Asian heart failure cohort across age |
| title_full | Tolerability for older, persistence for younger: a real-world evidence on sacubitril/valsartan in an Asian heart failure cohort across age |
| title_fullStr | Tolerability for older, persistence for younger: a real-world evidence on sacubitril/valsartan in an Asian heart failure cohort across age |
| title_full_unstemmed | Tolerability for older, persistence for younger: a real-world evidence on sacubitril/valsartan in an Asian heart failure cohort across age |
| title_short | Tolerability for older, persistence for younger: a real-world evidence on sacubitril/valsartan in an Asian heart failure cohort across age |
| title_sort | tolerability for older persistence for younger a real world evidence on sacubitril valsartan in an asian heart failure cohort across age |
| topic | sacubitril/valsartan age tolerability heart failure real-world study older patient |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1620266/full |
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