Key result
ACEi/ARBs are withheld from ~40% of NYHA III/IV heart failure patients due to limiting comorbidities.
Why the study?
Although ACE inhibitors and ARBs provide maximal benefit in heart failure, many patients do not receive them due to comorbidities, prompting an investigation into the limitations of their use in this population.
Observational (n=310)
No
A significant proportion (39.7%) of patients with severe heart failure in an Indian tertiary center do not receive guideline-directed ACEi/ARB therapy, primarily due to hypotension, hyperkalemia, and renal failure.
Many severe HF patients miss ACEi/ARBs due to comorbidities; leaves open optimal GDMT strategies for this population.
Background and Objectives: The essential drugs used in heart failure are angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers. Many trials had shown that these are the group of drugs with maximum benefits for the patients with heart failure. However, most of the patients were not receiving these drugs due to the negative impact of the comorbidities. Our study aims at identifying the limitations in giving ACE/angiotensin receptor blockers (ARBs) in chronic heart failure patients in our population. Methods: This is a prospective observational study conducted in a tertiary care center, over a period of 2 years from 2012. We selected 310 consecutive patients with the New York Heart Association (NYHA) Class 3 or 4 with various etiologies of heart failure. The patients with new-onset myocardial infarction, acute inflammatory conditions, septicemia, and end-stage renal disease with glomerular filtration rate (GFR) <30 were excluded from the study. Results: In our study population of 310 patients with various etiologies of heart failure, only 60.3% (187) of the patients received ACE/ARBs, in which 34.5% (107) received ACE inhibitors and 16.4% ( n -51) received ARB s. Hence, we noticed that 39.7% ( n -123) of the patients with heart failure could not receive these drugs due to renal failure (10.3%), hyperkalemia (13.5%), and hypotension (15.8%). Conclusion: We noticed that many of the patients (39.7%) with heart failure did not receive these drugs due to comorbidities. We found that many patients had moderate renal failure with a significant reduction in GFR. Hypotension may be due to reduced ejection fraction because of the patient selection of Class NYHA 3 or 4. Hypotension may reduce the GFR and hence the progressive rise of serum creatinine. Careful patient selection and detailed evaluation alone can improve the number of subjects to whom the above drugs can be given.
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Soman et al. (2020) conducted an observational in Heart failure (n=310). ACE inhibitors and ARBs was evaluated on Proportion of patients not receiving ACE/ARBs due to comorbidities. Among patients with NYHA Class 3 or 4 heart failure, 39.7% did not receive ACE inhibitors or ARBs due to comorbidities such as hypotension (15.8%), hyperkalemia (13.5%), and renal failure (10.3%).
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