Morbidity, mortality, physiologic and functional parameters in elderly and non-elderly patients in the Valsartan Heart Failure Trial (Val-HeFT)

Baruch, Lawrence; Glazer, Robert D.; Aknay, Nora; Vanhaecke, Johan; Thomas Heywood, J.; Anand, Inder; Krum, Henry; Hester, Allen; Cohn, Jay N.

doi:10.1016/j.ahj.2004.06.001

« Previous Next »American Heart Journal
Volume 148, Issue 6 , Pages 951-957, December 2004

Morbidity, mortality, physiologic and functional parameters in elderly and non-elderly patients in the Valsartan Heart Failure Trial (Val-HeFT)

Lawrence Baruch, MD
- Bronx VA Medical Center, Bronx, NY, USA
- Reprint requests: Lawrence Baruch, MD, Bronx VA Medical Center, 130 West Kingsbridge Road, Bronx , NY 10468, USA.
Robert D. Glazer, MD
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
Nora Aknay, BSc
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
Johan Vanhaecke, MD, PhD
- U.Z. Gasthuisberg, Leuven, Belgium
J. Thomas Heywood, MD
- Loma Linda University Medical Center, Loma Linda, Calif, USA
Inder Anand, MD, D Phil, FRCP
- VA Medical Center, Minneapolis, Minn, USA
Henry Krum, MBBS, PhD, FRACP
- Monash University Medical School, Alfred Hospital, Melbourne, VIC, Australia
Allen Hester, PhD
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
Jay N. Cohn, MD
- University of Minnesota, Minneapolis, Minn, USA

Received 20 February 2004; accepted 4 June 2004.

Abstract

Background

The Valsartan Heart Failure Trial (Val-HeFT) demonstrated the favorable effects of the addition of valsartan to prescribed heart failure (HF) therapy on HF hospitalization, and functional and physiological parameters. As the prevalence of HF morbidity and mortality are increased in the elderly, the effect of valsartan in the elderly is of clinical significance.

Methods

In this post-hoc analysis, morbidity, mortality, left ventricular (LV) size and function, brain natriuretic peptide (BNP), aldosterone, norepinephrine (NE), quality of life, and treatment effect with valsartan were examined by subgroups of 2350 elderly (≥ 65 years) and 2660 non-elderly (< 65 years) patients enrolled in Val-HeFT.

Results

While the overall incidence of morbidity and mortality was higher in the elderly, valsartan produced beneficial effects in reducing risk of morbidity in the elderly by 11.8% (P = .07), and the non-elderly by 14.6% (P = .09). Valsartan had no effect on mortality compared to placebo in the non-elderly, 15.2% vs 15.0% (P = .87), and elderly, 25.1% vs 24.0%, (P = .64). Valsartan had statistically significant beneficial effects in both the elderly and non-elderly on LV size and function, BNP, aldosterone and quality of life. Beneficial effects on NE were also observed with valsartan in both subgroups with statistically significant reductions produced in the non-elderly.

Conclusions

Val-HeFT demonstrated that elderly patients present with more advanced HF as evidenced by higher morbidity and mortality along with greater neurohormonal activation. In Val-HeFT, valsartan produced a consistent beneficial effect on morbidity, LV function and size, quality of life, and neurohormonal levels in both the elderly and non-elderly.