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We conducted a retrospective cohort study based on patient-level linkage of electronic healthcare datasets. Data from all adults with HFrEF in Belgium receiving a prescription for sacubitril\/valsartan between 01-November-2016 and 31-December-2018 were collected, with a follow-up of\u2009&gt;\u20096\u00a0years. The total study population comprised 5446 patients, older than the PARADIGM-HF trial participants, and with higher NYHA class (all P\u2009&lt;\u20090.0001). NYHA class improved following sacubitril\/valsartan initiation (P\u2009&lt;\u20090.0001 baseline vs. reassessment). Most concomitant medications were reduced. Remarkably, the risk of hospitalization for a cardiovascular reason and for HF was reduced by\u2009&gt;\u200926% in the overall cohort, and in subgroups of patients\u2009\u2265\u200975\u00a0years, with NYHA class III\/IV (all P\u2009&lt;\u20090.0001) or with NYHA class IV (P\u2009&lt;\u20090.05), vs. baseline. All-cause mortality did not increase in real-world patients with NYHA class III\/IV. The results support the long-term beneficial effects of sacubitril\/valsartan in older patients and in those experiencing the most severe symptoms.<\/jats:p>","DOI":"10.1038\/s41598-024-64243-w","type":"journal-article","created":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T10:02:47Z","timestamp":1718186567000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Real-life effectiveness of sacubitril\/valsartan in older Belgians with heart failure, reduced ejection fraction and most severe symptoms"],"prefix":"10.1038","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7517-1988","authenticated-orcid":false,"given":"El\u00e9onore","family":"Maury","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Belmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kris","family":"Bogaerts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefaan","family":"Vancayzeele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mieke","family":"Jansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,12]]},"reference":[{"issue":"11","key":"64243_CR1","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1056\/NEJMoa1409077","volume":"371","author":"JJ McMurray","year":"2014","unstructured":"McMurray, J. 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Sacubitril\/valsartan in real-life European patients with heart failure and reduced ejection fraction: A systematic review and meta-analysis. ESC Heart Fail 8(5), 3547\u20133556 (2021).","journal-title":"ESC Heart Fail"},{"issue":"38","key":"64243_CR6","doi-asserted-by":"publisher","first-page":"2576","DOI":"10.1093\/eurheartj\/ehv330","volume":"36","author":"PS Jhund","year":"2015","unstructured":"Jhund, P. S. et al. Efficacy and safety of LCZ696 (sacubitril-valsartan) according to age: Insights from PARADIGM-HF. Eur. Heart J. 36(38), 2576\u20132584 (2015).","journal-title":"Eur. Heart J."},{"key":"64243_CR7","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.ahj.2022.04.007","volume":"250","author":"L Gilstrap","year":"2022","unstructured":"Gilstrap, L. et al. Sacubitril\/valsartan vs ACEi\/ARB at hospital discharge and 5-year survival in older patients with heart failure with reduced ejection fraction: A decision analysis approach. Am. 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S.V. was employee of the sponsor. A.B and K.B received consulting fees from Novartis through their institution during the conduct of this study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"13512"}}