Real-world persistence with sacubitril/valsartan in patients with heart failure in France: A claims database study

Information on treatment persistence and tolerability of sacubitril/valsartan (S/V) in elderly patients with heart failure (HF) is limited.

To evaluate treatment persistence, adherence and safety-related events in patients with HF treated with S/V, and to compare outcomes in subgroups of patients younger and older than 75 years.

This observational study was performed using the French national healthcare claims database. All patients who started S/V between April 2015 and December 2020 were eligible and were followed until 31 December 2020 or death. All deliveries of medication were documented. Persistence was defined as the interval between the first delivery and permanent discontinuation. Adherence was defined as the proportion of days covered (PDC). Adverse events of special interest (AESIs) were hospitalizations for hypotension, acute renal failure, hyperkalaemia or angioedema. All-cause mortality was documented.

A total of 104,910 patients were enrolled, including 44,743 (42.6%) aged ≥75 years. Median (interquartile range [IQR]) follow-up duration was 18.1 (8.5-30.1) months. Twelve-month persistence rates (95% confidence intervals) were 83.0% (82.7-83.2) overall, 86.0% (85.7-86.3) in patients aged <75 years and 78.7% (78.3-79.1) in patients aged ≥75 years. The median (IQR) PDC was 0.90 (0.82-0.96), with no significant difference between the two age groups. Hospitalizations with AESIs were documented in 20,624 patients (19.7%), were more frequent in patients aged ≥75 years (22.8%) than in younger patients (17.3%) and were associated with concomitant discontinuation of S/V in 3408 patients (3.2%; <75 years: 2.3%; ≥75 years: 4.0%).

S/V can be considered a suitable treatment option for patients aged ≥ 75 years with HF.