1. Discontinuation/Dose Reduction of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers during Acute Decompensated Heart Failure in African-American Patients with Reduced Left-Ventricular Ejection Fraction
- Author
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Louis Salciccioli, Syed Abbas Haidry, Joseph K Kim, Jason Lazar, and Jesse A Kane
- Subjects
Male ,medicine.medical_specialty ,Acute decompensated heart failure ,Adrenergic beta-Antagonists ,Angiotensin-Converting Enzyme Inhibitors ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Ventricular Function, Left ,03 medical and health sciences ,Angiotensin Receptor Antagonists ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Heart Failure ,Angiotensin II receptor type 1 ,Ejection fraction ,biology ,Dose-Response Relationship, Drug ,business.industry ,Angiotensin-converting enzyme ,Stroke Volume ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,United States ,Discontinuation ,Black or African American ,Hospitalization ,Heart failure ,Creatinine ,Multivariate Analysis ,biology.protein ,Cardiology ,Hyperkalemia ,Dose reduction ,Female ,Angiotensin Receptor Blockers ,Hypotension ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives: Patients with heart failure (HF) and reduced left-ventricular ejection fraction (LVEF) benefit from angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB) therapy. While dose reduction/discontinuation (r/d) of β-blockers (BB) and furosemide in acute decompensated HF (ADHF) worsen outcomes, data on ACEI/ARB are lacking. Methods: To determine the frequency and reasons for ACEI/ARB therapy r/d in ADHF patients, we studied 174 patients with LVEF Results: ACEI/ARB doses were r/d in 17.2% because of acute kidney injury (56.7%), hypotension (23.3%), and hyperkalemia (10%). Clinical characteristics were similar between patients with r/d and continued therapy. Admission and discharge creatinine (Cr) levels were higher in the r/d group. On multivariate analysis, admission Cr and admission systolic blood pressures were independent predictors of r/d. Among patients with renal dysfunction cited as the r/d reason, Cr did not significantly rise in 23.5%. The r/d group had a longer length of stay (LOS). Conclusions: ACEI/ARB dose is reduced and/or discontinued in nearly one-fifth of all ADHF admissions, and LOS is longer in the ACEI/ARB r/d group. While impaired renal function is the most frequently cited reason, nearly one-fourth of the patients had stable renal function. ACEI/ARB r/d therapy in the setting of ADHF merits further study.
- Published
- 2016