Real-world use of vericiguat in elderly patients with heart failure: insights from the OPTIMA-HF registry
S Giovinazzo, S Paolillo, P Gargiulo, F Marzano, P Agostoni, P Severino, N D Brunetti, P Calabro', M Cameli, G Sinagra, G Patti, S Nodari, F Guerra, P Perrone-Filardi, P AmeriAbstract
Background/Introduction
Real-world evidence on the use of vericiguat in elderly patients with HF remains limited.
Purpose
We sought to determine the features and early outcomes of old patients initiated on vericiguat for HF with reduced ejection fraction and a recent decompensation.
Methods
We retrospectively collected data from patients with a new prescription of vericiguat at centres participating in the Italian nationwide OPTIMA-HF registry. Baseline characteristics, clinical response, and follow-up events were compared between subjects with <75 and ≥75 years (hereafter, <75 yr and ≥75 yr).
Results
Of 572 patients included in the snapshot, 189 (33%) were ≥75 yr. Compared with <75 yr, they had lower BMI and more severe HF, with more frequent NYHA class III-IV and signs of congestion, higher estimated systolic pulmonary artery pressure, and higher NT-proBNP levels (Figure, panel A). LVEF was higher in older than younger patients, and there was a greater representation of HF with improved LVEF in the former than the latter. The ≥75 yr patient subgroup was also characterized by lower haemoglobin levels and eGFR. Moreover, they were less often treated with sacubitril-valsartan and MRA (panel B). Based on available information from 465 (81.3%) subjects with median follow-up of 4.4 [2.7-7.2] and 4.6 [2.9-8.8] months for <75 yr and ≥75 yr, respectively, discontinuation of vericiguat was numerically more frequent in older patients (23.6% vs 17.9%, p=0.179). Titration to >2.5 mg QD was attained in 22.6% and 24.4%, respectively (p=0.677). Changes in NYHA class (panel C), LVEF (+9.3%, 95%CI 6.1%-12.5% in <75 yr and +8.1%, 95%CI 4.3%-11.9% in ≥75 yr; p=0.660), and NT-proBNP (-11.9%, 95%CI -19.6% to -1.8% in <75 yr and -12.6%%, 95%CI -26.9% to 0% in ≥75 yr; p=0.792) were comparable between groups. Need of iv diuretic therapy (8.2% vs 7.4%; HR 0.92, 95% CI 0.43-1.95, p=0.827), HF hospitalization (21.4% vs 24%, HR 1.04, 95%CI 0.68-1.59, p=0.838), and all-cause mortality (<75 yr: 15.3 [9.2-24] /100 person-year; ≥75 yr: 15.8 [8.8-26] /100 person-year) were also similar in patients <75 yr or ≥75 yr.
Conclusions
In a real-world setting, treatment with vericiguat appears feasible in elderly patients with HF, despite their more complex and advanced clinical phenotype, with similar early outcomes compared with younger patients.For image description, please refer to the figure legend and surrounding text.