Baseline beta-blockers and/or renin-angiotensin system inhibitors were associated with lower in-hospital mortality in acute heart failure, especially when combined (OR 0.699; 95% CI 0.580-0.843).
Observational (n=17,916)
Sí
Does baseline treatment with beta-blockers, renin-angiotensin system inhibitors, or both reduce in-hospital all-cause mortality in patients presenting with acute heart failure?
Baseline treatment with beta-blockers, renin-angiotensin system inhibitors, or both is associated with significantly lower in-hospital mortality in patients presenting with acute heart failure.
Estimación del efecto: OR 0.699 (95% CI 0.580-0.843)
INTRODUCTION Baseline treatment with beta-blockers (BB) and/or renin-angiotensin system inhibitors (RASi) has been extensively studied in the context of heart failure, given its fundamental role in modulating the neurohormonal axis and improving survival. OBJECTIVE To investigate whether there is an association between receiving baseline treatment with BB or RASi, either alone or in combination, and the short-term prognosis of an episode of acute heart failure (AHF). METHOD Patients from the EAHFE registry (Epidemiology of Acute Heart Failure in Spanish Emergency Departments) were analyzed. This is a multicenter, prospective, multipurpose registry that collects all AHF episodes presenting to participating hospital emergency departments (EDs) over a period of 1 to 2 months between 2007 and 2018. The primary outcome variable investigated was in-hospital all-cause mortality during the ED stay or hospitalization. Adjusted analyses were conducted using multiple logistic regression and multiple imputation to control for potential confounding factors. RESULTS The study included a total of 17,916 episodes of acute heart failure (AHF). A total of 26.2% of patients did not receive treatment with either beta-blockers (BB) or renin-angiotensin system inhibitors (RASi), constituting the reference group. Overall, 17.8% of patients received BB only, 30.4% were treated exclusively with RASi, and 25.7% received a combination of both drugs. The mean age of the patients was 80.4 years (standard deviation 10.2 years), and 55.7% were women. In-hospital mortality was 7.3%. After multivariable adjustment, a significant association with lower mortality was found for treatment with BB alone (odds ratio OR = 0.826, 95% confidence interval CI 0.685-0.996), OR = 0.709 (CI95% 0.600-0.837) RASi alone and for combined treatment with RASi and BB (OR = 0.699, 95%CI 0.580-0.843). In the adjusted model with multiple imputation, the results remained significant. CONCLUSIONS In patients with an episode of AHF, baseline treatment with BB, RASi, or both is associated with lower all-cause mortality. This association is strongest in the group of patients receiving both treatments combined, and the results remain significant after multivariate adjustment.
Haro et al. (Tue,) conducted a observational in Acute heart failure (n=17,916). Baseline treatment with beta-blockers and/or renin-angiotensin system inhibitors vs. No treatment with either beta-blockers or renin-angiotensin system inhibitors was evaluated on In-hospital all-cause mortality during the ED stay or hospitalization (OR 0.699, 95% CI 0.580-0.843). Baseline beta-blockers and/or renin-angiotensin system inhibitors were associated with lower in-hospital mortality in acute heart failure, especially when combined (OR 0.699; 95% CI 0.580-0.843).