Reduced administration of Angiotensin-Converting Enzyme inhibitors on admission was significantly associated with increased two-year mortality in patients with advanced heart failure (p=0.044).
Observational (n=647)
Does the type of pharmacotherapy regimen affect in-hospital and two-year mortality in patients hospitalized with advanced heart failure?
Reduced administration of ACE inhibitors on admission is associated with increased mortality in patients hospitalized with advanced heart failure.
p-value: p=0.044
Abstract Introduction Heart failure is a leading cause of morbidity and mortality worldwide. Pharmacotherapy is crucial for the management of heart failure, aiming to reduce symptoms and improve survival. Purpose The present study focuses on patients with advanced heart failure, with the objective of evaluating the effectiveness of therapeutic regimens on in-hospital and two-year mortality. Materials and Method This is a retrospective observational study that included patients with NYHA Class III-IV heart failure who had at least one hospitalization between January 1, 2022, and December 31, 2022. These hospitalizations were due to either newly diagnosed heart failure or the worsening of the functional stage of pre-existing heart failure. Demographic, clinical, and pharmacological data were collected from medical records, including the type, dosage, and adherence to medication, as well as related hospitalizations, complications, and endpoints (e.g., readmissions, mortality). Results The total sample comprised 647 patients, with a mean age of 73±13.7 years, of whom 33.5% were women. Data analysis over the two-year period revealed that patients who died had a lower rate of Angiotensin-Converting Enzyme inhibitor (ACEi) administration upon admission compared to those who survived (35% versus a higher percentage, p=0.044). Conversely, no statistically significant differences were observed between the two groups (survivors and deceased) regarding the use of other drug classes, such as Angiotensin Receptor-Neprilysin Inhibitors (ARNI), beta-blockers (BB), Mineralocorticoid Receptor Antagonists (MRA), digoxin, and SGLT2 inhibitors. Notably, at hospital discharge, there was an increase in the prescribed dose of ACEi among the deceased patients (53% versus 35% at admission); however, this was not associated with improved survival. The comparison of therapeutic regimens between the two groups did not reveal any statistically significant differences across medication categories. Conclusions This study demonstrated that reduced administration of Angiotensin-Converting Enzyme inhibitors (ACEi) on admission is statistically significantly associated with increased mortality in patients with advanced heart failure. None of the applied therapeutic regimens were linked to a statistically significant reduction in two-year mortality in the study population. These findings underscore the importance of timely and optimal pharmacological intervention, while also highlighting the multifactorial nature of outcomes in patients with advanced heart failure.
Kouremeti et al. (Mon,) conducted a observational in Advanced heart failure (n=647). Angiotensin-Converting Enzyme inhibitors (ACEi) vs. Higher rate of ACEi administration was evaluated on Two-year mortality (p=0.044). Reduced administration of Angiotensin-Converting Enzyme inhibitors on admission was significantly associated with increased two-year mortality in patients with advanced heart failure (p=0.044).