Effect of Prescribing Patterns of Renin-Angiotensin System Blockers and Beta-Blockers on Prognosis of Heart Failure

Link to article at PubMed

Adv Ther. 2020 Jul 16. doi: 10.1007/s12325-020-01443-6. Online ahead of print.


INTRODUCTION: Use of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) only, beta-blockers (BB) only, or both has been rarely compared in patients with heart failure (HF). We evaluated the prescribing patterns of ACEi/ARB and BB on prognosis in HF according to left ventricular function.

METHODS: Study data were obtained from a national multicenter cohort that included patients hospitalized for HF. Patients were classified into four groups according to the prescription pattern at discharge: all ACEi/ARB and BB treatment group, only ACEi or ARB treatment group, only BB treatment group, and neither ACEi/ARB nor BB group.

RESULTS: Use of both ACEi/ARB and BB had significantly lowest all-cause death rates among the four groups in all types of HF. Cox regression analysis showed that use of both drugs was independently associated with 51% reduced risk of all-cause death in patients with HF with preserved ejection fraction (HFpEF) and HF with mid-range ejection fraction (HFmrEF). Treatment with only ACEi/ARB also showed an independent association with a 52% reduction in this group. However, only BB treatment was not associated with reducing long-term mortality in patients with HFpEF and HFmrEF. In patients with HF with reduced ejection fraction, use of ACEi/ARB and/or BB revealed an independent association with a reduced risk of all-cause death regardless of prescribing patterns.

CONCLUSIONS: Prescribing patterns were diverse in HF and there was a difference in the degree of risk reduction in all-cause death. In particular, clinicians should consider ACEi/ARB first for patients with HFpEF and HFmrEF prior to BB.

PMID:32676928 | DOI:10.1007/s12325-020-01443-6

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