Abstract:

Objective To explore the short⁃term efficacy and safety of low⁃dose combined with recombi⁃nant human brain natriuretic peptide and sacubitril⁃valsartan in the treatment of elderly patients with acute heartfailure. Methods 142 elderly patients with New York Heart Function Ⅲ~Ⅳ and NT⁃roBNP significantlyincreased and ejection fraction significantly decreased were randomLy divided into observation group（group A），conventional + recombinant human brain natriuretic peptide group（group B）and conventional treatment group（Group C），47 cases，47 cases and 48 cases respectively. All patients were treated with diuretics，digoxin and othersymptomatic treatment according to their condition. Group A received 0.5 mg/day recombinant human brain natri⁃uretic peptide（rhBNP）on the basis of routine treatment for the first three days，and at the same time，sacubitril⁃valsartan，25 mg bid orally for the first time，titrated according to blood pressure level；group B received rhBNPfor the first three days on the basis of routine treatment；group C received routine treatment. The clinical symptomrelief，clinical remission time，heart function improvement，six minute walking distance，blood pressure changeand NT⁃proBNP level were compared among the three groups. Results After treatment，the ventricular rate andNT proBNP level of the three groups were significantly lower than that before admission（P < 0.001）. In group A，diastolic blood pressure decreased after treatment（P < 0.001）. The clinical remission in group A were less than those in group C，and there were significant differences between the two groups（P < 0.001）. The six minute walkingdistance in group A was greater than that in group C（P < 0.001）；the diastolic blood pressure in group A was lowerthan that in group C（P = 0.006）；the NT⁃proBNP level in group A was lower than that in group C and group B（P < 0.001）at the first week of treatment；at the same time，the NT⁃proBNP level in group B was lower than thatin group C（P < 0.001）. There was no significant difference in the improvement of cardiac function among the threegroups（P = 0.051）. There were 9 hospital deaths in all patients，3 in each group. The mean age and the NT⁃proB⁃NP level of the patients who died in hospital was significant higher than those of the patients who were alive inhospital（P < 0.001）；the ventricular rate and EF value of the patients who died in hospital were significantly lowerthan those of the patients who were alive in hospital（P < 0.001）. Conclusion Early combined use of rhBNP andsacubitril⁃valsartan in small doses can further improve the short⁃term prognosis of elderly patients with acute heartfailure compared with conventional treatment regimens.

Key words: elderly patients, acute heart failure, recombinant human brain natriuretic peptide, sa?cubitril?valsartan