Key result
ACEi/ARB prescriptions in the first 7 days of ADHF admission were associated with lower odds of worsening renal function (aOR 0.70, 95% CI 0.57-0.87) and in-hospital mortality (aOR 0.54).
Why the study?
Associations between early inpatient neurohormonal antagonist prescriptions and outcomes in ADHF remain incompletely characterized across kidney function and heart failure subtypes.
Does early inpatient prescription of ACEi/ARB, beta-blockers, and MRAs reduce worsening renal function and in-hospital mortality in patients admitted with acute decompensated heart failure across CKD and LVEF strata?
Cohort (n=2,208)
Does early inpatient prescription of ACEi/ARB, beta-blockers, and MRAs reduce worsening renal function and in-hospital mortality in patients admitted with acute decompensated heart failure across CKD and LVEF strata?
Answers are grounded in this paper and cite their sources.
Early inpatient ACEi/ARB and MRA use in acute decompensated heart failure is associated with lower odds of worsening renal function and in-hospital mortality, particularly in HFrEF regardless of CKD status, though associations attenuate when accounting for onset timing.
Background Associations between early inpatient neurohormonal antagonist prescriptions and outcomes in acute decompensated heart failure (ADHF) remain incompletely characterized across kidney function and heart failure subtypes. Methods In 2208 ADHF admissions, adjusted logistic regression assessed ACE inhibitor/angiotensin receptor blocker (ACEi/ARB), beta-blocker, and mineralocorticoid receptor antagonist (MRA) prescriptions during the first seven days in relation to worsening renal function (WRF), mortality, and their composite, stratified by CKD and ejection fraction. Sensitivity analyses examined a day-7 landmark cohort and pre-admission medication history. Results ACEi/ARB prescriptions were associated with lower adjusted odds of WRF (adjusted odds ratio [aOR] 0.70, 95% confidence interval [CI] 0.57–0.87) and in-hospital mortality (aOR 0.54, 95% CI 0.34–0.86); MRA showed similar associations, whereas beta-blockers showed none. Significant estimates were observed in HFrEF (WRF aOR 0.61 for ACEi/ARB and 0.53 for MRA) but generally not in LVEF >40%, and CKD status did not modify these associations (all P for interaction >0.05). In a day-7 landmark analysis excluding early WRF, first-onset WRF associations were attenuated and no longer significant overall but persisted in HFrEF. New ACEi/ARB and MRA users had lower WRF odds than never users but did not differ from continuing users; continuing beta-blocker users had higher WRF odds than new users. Conclusion In this ADHF cohort, ACEi/ARB and MRA use was associated with lower odds of WRF, but associations weakened after accounting for onset timing and remained significant only in HFrEF. These observational findings do not establish treatment benefit.
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Yang et al. (2026) conducted a cohort in Acute decompensated heart failure (ADHF) (n=2,208). Early inpatient ACEi/ARB, beta-blocker, and MRA prescriptions vs. No prescription / never users was evaluated on Worsening renal function (WRF) (aOR 0.70, 95% CI 0.57-0.87). ACEi/ARB prescriptions in the first 7 days of ADHF admission were associated with lower odds of worsening renal function (aOR 0.70, 95% CI 0.57-0.87) and in-hospital mortality (aOR 0.54).
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