Discharge treatment with ACE inhibitor/ARB after a heart failure hospitalization is associated with a better prognosis irrespectively of left ventricular ejection fraction.
Intern Med J. 2019 Mar 19;:
Authors: Vicent L, Cinca J, Vazquez-García R, Gonzalez-Juanatey JR, Rivera M, Segovia J, Pascual-Figal D, Bover R, Worner F, Delgado-Jiménez J, Fernández-Avilés F, Martínez-Sellés M
BACKGROUND: Medical therapy could improve the prognosis of real-life patients discharged after a heart failure (HF) hospitalization. We aimed to determine the impact of discharge HF treatment on mortality and readmissions in different left ventricular ejection fraction (LVEF) groups.
METHODS: Multicentre prospective registry in 20 Spanish hospitals. Patients were enrolled after a HF hospitalization.
RESULTS: A total of 1831 patients were included (583 [31.8%] HF with reduced ejection fraction [HFrEF]; 227 [12.4%] HF with midrange ejection fraction [HFmrEF]; 610 [33.3%] HF with preserved ejection fraction [HFpEF], and 411 [22.4%] with unknown LVEF. Angiotensin-converting enzyme (ACE) inhibitors/Angiotensin II receptor blockers (ARB) at discharge were independently associated with a reduction in: i) all-cause mortality: hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.41-0.74, P<0.001, with a similar effect in the four groups; ii) mortality due to refractory HF HR 0.45, 95% CI 0.29 - 0.64, P<0.001, with a similar effect in the three groups with known LVEF; iii) mortality/HF admissions (HR 0.61; 95% CI: 0.50-0.74), more evident in HFrEF (HR 0.54; 95% CI: 0.38 - 0.78) compared to HRmEF (HR 0.64; 95% CI 0.40 -1.02), or HFpEF (HR 0.70; 95% CI 0.53 - 0.92). In patients with HFrEF triple therapy (ACE inhibitor/ARB+ betablocker+ mineralocorticoid receptor antagonist) was associated with the lowest mortality risk (HR 0.21; 95% CI: 0.08-0.57, P=0.002) compared to patients that received none of these drugs.
CONCLUSIONS: Discharge treatment with ACE inhibitor/ARB after a HF hospitalization is associated with a reduction in all-cause and refractory HF mortality, irrespectively of LVEF. This article is protected by copyright. All rights reserved.
PMID: 30887642 [PubMed - as supplied by publisher]