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Abstract Aims The poor control of symptoms in patients with advanced heart failure with reduced ejection function (HFrEF) can limit the functionality of patients. Sacubitril–valsartan, compared with enalapril, has been shown to reduce mortality and hospitalization, and nowadays, there is still little evidence about the improvement on functionality. The aim of our study is to analyse the improvement of the functional class and the 6 min walking test (6MWT) in patients with multiple pathologies and advanced heart failure. Methods and results From September 2016 to March 2018, 65 multimorbidity patients with severe symptomatic HFrEF were initiated to receive sacubitril–valsartan. Mean age was 78.6 ± 7.4 years, and 68% were male. The Charlson co-morbidity index was 8 points. Seventy-four per cent had New York Heart Association (NYHA) Functional Class IV. After the treatment, patients were able to achieve 55.68 m or more on 6MWT, and 91% presented an improvement in the NYHA functional class. Conclusions Sacubitril–valsartan relieves symptoms and improves functional class prognostic risk of patients with advanced HFrEF and co-morbidity.

[...]we have not evaluated the quality of life with validated scales. [...]an increase in the distance walked in the 6MWT has been observed. Answer: We apologize for not having included this information before. Since the study was not funded, and considering that the payments received are not related to the present study, we believed that they were not necessary.