The frailty status of patients with HFpEF should have no bearing on whether those patients receive sacubitril/valsartan, which was found to be safe and well tolerated regardless of frailty in a pivotal trial. ESCCongress MedTwitter
Analysis of the treatment effect by sacubitril/valsartan compared with valsartan in patients with HFpEF in PARAGON-HF showed that sacubitril/valsartan actually benefited patients more as their frailty increased when researchers applied frailty severity as a continuous variable.
When they analyzed frailty's effect by dividing the study cohort into three subgroups based on frailty severity — not frail, more frail, and most frail — the statistical analysis showed no significant heterogeneity of effect, although the point estimates for each subgroup showed by far the biggest benefit among the most frail patients. A safety analysis showed consistent safety of sacubitril/valsartan compared with valsartan across all three frailty subgroups, Butt reported.
Butt went a step further and stressed,"I don't think we should measure frailty" when considering patients with heart failure for treatment with sacubitril/valsartan, or with dapagliflozin, which had shown safety and maintained efficacy in a prespecified
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