Associations of Acid Suppressive Therapy With Cardiac Mortality in Heart Failure Patients

Background It has been recently reported that histamine H 2 receptor antagonists (H2 RA s) are associated with impairment of ventricular remodeling and incident heart failure. In addition, favorable pleiotropic effects and adverse effects of proton pump inhibitors ( PPI s) on cardiovascular disease have also been reported. We examined the associations of acid suppressive therapy using H2 RA s or PPI s with cardiac mortality in patients with heart failure. Methods and Results In total, 1191 consecutive heart failure patients were divided into 3 groups: a non–acid suppressive therapy group (n=363), an H2 RA group (n=164), and a PPI group (n=664). In the follow‐up period (mean 995 days), 169 cardiac deaths occurred. In the Kaplan–Meier analysis, cardiac mortality was significantly lower in the PPI group than in the H2 RA and non–acid suppressive therapy groups (11.0% versus 21.3% and 16.8%, respectively; log‐rank P =0.004). In the multivariable Cox proportional hazards analysis, use of PPI s, but not H2 RA s, was found to be an independent predictor of cardiac mortality ( PPI s: hazard ratio 0.488, P =0.002; H2 RA s: hazard ratio 0.855, P =0.579). The propensity‐matched 1:1 cohort was assessed based on propensity score (H2 RA s, n=164; PPI s, n=164). Cardiac mortality was significantly lower in the PPI group than in the H2 RA group in the postmatched cohort (log‐rank P =0.025). In the Cox proportional hazards analysis, the use of PPI s was a predictor of cardiac mortality in the postmatched cohort (hazard ratio 0.528, P =0.028). Conclusions PPI s may be associated with better outcome in patients with heart failure.