Age-stratified and sex-stratified effect of angiotensin receptor-neprilysin inhibitor in heart failure with reduced ejection fraction-data from PARADE-HF: nationwide medication adherence study

초록

Methods: We analyzed longitudinal cohort data for patients with HFrEF using from the Korean National Health Insurance Service data (2017-2021) covering the entire population. 13,483 patients each receiving ARNI and RAS blocker (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker) who matched baseline characteristics through the propensity score, were categorized into sex and age group (<50 years, 50-60 years, 60-70 years, 70-80 years, and ≥80 years). The primary outcome was composite of all-cause mortality or any hospitalization during 1 year. Results: 16,806 (62.3% of whole study population) patients were men. The mean age of study population was 68.6 ± 13.7 years old, with 2,653 (9.8%) participants younger than 50 years, 3,956 (14.7%) aged 50-59 years, 6,210 (23.0%) 60-69 years, 8,014 (29.7%) 70-79 years, and 6133 (22.7%) 80 years and older. Patients with ARNI had a lower risk of developing the primary outcome than patients with RAS blockades. (hazard ratio [HR] 0.78; 95% confidence interval [CI] 0.75-0.81; P <0.001). The cumulative incidence for primary outcome stratified by age categories showed increasing incidence by increasing age (Figure). In men, receiving ARNI lowered the risk of the primary composite outcome occurring in patients aged 50 years or older, and the relative treatment effect was greater in patients aged 80 years or older (Table & Figure). The risk reduction of ARNI for all-cause mortality was not statistically significant, whereas that of ARNI for any hospitalization showed a similar pattern (table). In women, the treatment effect of ARNI to reduce primary outcome was observed in patients aged 60 years or older, and the risk reduction of ARNI was greater in patients aged 80 years or older, also(Table & Figure). The ARNI was effective in reducing of risk of all-cause mortality and any hospitalization in age 60 years or older. In patients aged 60 or older, the risk reduction effect of ARNI was similar in both sexes. Conclusion: The risk-reducing effect of ARNI was observed in middle-aged and older patients, with no gender difference. And treatment effect of ARNI was maximized in extremely old patients. Through this, it can be another evidence that ARNI is effective even in elderly patients.