Discharge on ACEI/ARB was associated with lower 30-day (HR 0.36; 95% CI 0.25-0.52) and 180-day mortality (HR 0.23; 95% CI 0.19-0.27) in patients with acute heart failure.
Cohort (n=3,652)
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Does discharge on ACEI/ARB reduce 30- and 180-day mortality in patients hospitalized for acute heart failure with reduced ejection fraction?
Discharge on ACEI/ARB is associated with significantly lower 30- and 180-day mortality in patients hospitalized for acute HFrEF, though higher admission serum creatinine often leads to its discontinuation.
Hazard Ratio: 0.36 (95% CI 0.25–0.52)
OBJECTIVE: The aim of the study was to determine patterns and predictors of utilization of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) in patients with acute heart failure (AHF) and changes in kidney function at admission, hospitalization, and discharge in relation to clinical outcomes. METHODS: This retrospective analysis of the Veterans' Health Administration data (2016) included patients with heart failure (HF) with reduced ejection fraction who were hospitalized. Patients with an estimated glomerular filtration <15 cm3/min/1.73 m2 and those on dialysis were excluded. Patients were categorized based on the use of ACEI/ARB as continued, initiated, discontinued, or no therapy. Multivariable logistic regression evaluated predictors of being discharged home on an ACEI/ARB. Cox regression analysis evaluated outcomes (30 and 180-day mortality/HF readmissions). RESULTS: 3,652 patients were included, of which 37% of patients hospitalized for AHF had ACEI/ARB discontinued on admission, or not initiated. After adjusting for age, blood pressure, and serum potassium, a per-unit increase in admission serum creatinine (SCr) was independently associated with lower rates of continuation or initiation of ACEI/ARB odds ratio 0.51 95% confidence interval (CI) (0.46-0.57). Discharge on ACEI/ARB was independently associated with lower odds of 30- and 180-day mortality hazard ratio (HR) 0.36 95% CI (0.25-0.52), and HR 0.23 95% CI (0.19-0.27), respectively. CONCLUSION: Higher SCr at admission is an important determinant of ACEI/ARB being discontinued or withheld in patients admitted with AHF. ACEI/ARB at discharge was associated with lower mortality in patients with AHF.
Mathew et al. (Fri,) conducted a cohort in Acute heart failure with reduced ejection fraction (n=3,652). ACEI/ARB at discharge vs. No ACEI/ARB at discharge was evaluated on 30-day mortality (HR 0.36, 95% CI 0.25-0.52). Discharge on ACEI/ARB was associated with lower 30-day (HR 0.36; 95% CI 0.25-0.52) and 180-day mortality (HR 0.23; 95% CI 0.19-0.27) in patients with acute heart failure.