Higher achieved doses of ACEI/ARB reduced mortality or HF hospitalization regardless of age (HR 0.92; 95% CI 0.91-0.94), while higher beta-blocker doses only benefited younger patients.
Cohort (n=1,720)
Does up-titration of ACEI/ARB and beta-blockers improve outcomes across the age spectrum in patients with HFrEF?
Achieving higher doses of ACEI/ARB improves outcomes in HFrEF regardless of age, whereas higher doses of beta-blockers may only benefit younger patients.
Effect estimate: HR 0.92 (95% CI 0.91-0.94)
p-value: p=<0.001
AIMS: Several studies have shown that older patients with heart failure with reduced ejection fraction (HFrEF) are undertreated. The aim of this study was to evaluate the association of up-titration of angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) and beta-blockers on outcome across the age spectrum in HFrEF patients. METHODS AND RESULTS: We analysed HFrEF patients on sub-optimal doses of ACEI/ARB and/or beta-blockers from the BIOSTAT-CHF study stratified by age. Patients underwent a 3-month up-titration period. We used inverse probability weighting to adjust for the likelihood of successful up-titration to determine the association of achieved dose with mortality and/or heart failure hospitalisation, testing for an interaction with age. Over a median follow-up of 21 months in 1720 HFrEF patients (76.5% male, mean age 67 years), the primary outcome occurred in 558 patients. Increased percentage of target dose of ACEI/ARB and beta-blocker achieved at 3 months were both significantly associated with reduced incidence of the primary outcome, ACEI-ARB: hazard ratio (HR) per 12.5% increase in dose: 0.92, 95% confidence interval (CI) 0.91-0.94, P < 0.001; beta-blocker: HR 0.98, 95% CI 0.95-1.00, P = 0.046, with a significant interaction with age seen for beta-blockers but not ACEI/ARB (P = 0.034 and P = 0.22, respectively). CONCLUSIONS: Achieving higher doses of ACEI/ARB was associated with improved outcome regardless of age. However, achieving higher doses of beta-blockers was only associated with improved outcome in younger, but not in older patients.
Mordi et al. (Wed,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=1,720). Up-titration of ACEI/ARB and beta-blockers vs. Lower achieved doses was evaluated on Mortality and/or heart failure hospitalisation (HR 0.92, 95% CI 0.91-0.94, p=<0.001). Higher achieved doses of ACEI/ARB reduced mortality or HF hospitalization regardless of age (HR 0.92; 95% CI 0.91-0.94), while higher beta-blocker doses only benefited younger patients.