In patients with HFnon-rEF, ARB use was associated with similar rates of CV death or heart failure rehospitalization compared with ACEi (adjusted HR 0.94; 95% CI 0.75-1.17; P=.556).
Cohort (n=5,837)
Yes
Does ARB therapy improve outcomes compared to ACEi or non-RASi therapy in patients with heart failure with nonreduced ejection fraction following acute heart failure hospitalization?
In patients with HFnon-rEF, ARB therapy at discharge was associated with lower all-cause mortality compared to ACEi, though cardiovascular outcomes were similar, suggesting a potential benefit that requires further prospective validation.
Effect estimate: adjusted HR 0.94 (95% CI 0.75-1.17)
p-value: p=.556
Background The comparative effectiveness of angiotensin-converting enzyme inhibitors (ACEis) versus angiotensin receptor blockers (ARBs) in heart failure with nonreduced ejection fraction (HFnon-rEF) remains uncertain. We evaluated long-term outcomes of these therapies in a real-world cohort following hospitalization for acute heart failure. Methods This retrospective multicenter study (2005-2019) included 5837 patients with HFnon-rEF (left ventricular ejection fraction ≥ 40%). Patients were categorized by discharge prescription into ACEi, ARB, or non-renin-angiotensin system inhibitor (RASi) groups. A 14-day landmark approach ensured pharmacological stabilization and reduced time-related bias. Inverse probability of treatment weighting was used to balance covariates (SMD < 0.1). The primary outcome was a composite of cardiovascular (CV) death or heart failure rehospitalization at 1 year. Results The primary composite outcome was similar between ARB and ACEi users (adjusted hazard ratio HR, 0.94; 95% confidence interval CI, 0.75-1.17; P = .556). However, ARB therapy was associated with lower all-cause mortality compared with ACEi (adjusted HR, 0.74; 95% CI, 0.55-0.99; P = .041) and non-RASi (adjusted HR, 0.80; 95% CI, 0.67-0.94; P = .008). Subgroup analyses showed generally consistent directional associations between ARB use and lower mortality, although these findings were exploratory. Conclusions In this real-world cohort of patients with HFnon-rEF, ARB use was associated with lower all-cause mortality compared with ACEi, despite similar CV outcomes. These findings do not establish superiority and should be interpreted as hypothesis-generating.
Lin et al. (Fri,) conducted a cohort in Heart failure with nonreduced ejection fraction (HFnon-rEF) (n=5,837). Angiotensin receptor blockers (ARBs) vs. Angiotensin-converting enzyme inhibitors (ACEis) and non-renin-angiotensin system inhibitors (RASi) was evaluated on Composite of cardiovascular (CV) death or heart failure rehospitalization at 1 year (adjusted HR 0.94, 95% CI 0.75-1.17, p=.556). In patients with HFnon-rEF, ARB use was associated with similar rates of CV death or heart failure rehospitalization compared with ACEi (adjusted HR 0.94; 95% CI 0.75-1.17; P=.556).