1. Initiation, Continuation, or Withdrawal of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction.
- Author
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Gilstrap, Lauren G, Fonarow, Gregg C, Desai, Akshay S, Liang, Li, Matsouaka, Roland, DeVore, Adam D, Smith, Eric E, Heidenreich, Paul, Hernandez, Adrian F, Yancy, Clyde W, and Bhatt, Deepak L
- Subjects
Humans ,Angiotensin-Converting Enzyme Inhibitors ,Stroke Volume ,Hospitalization ,Patient Readmission ,Withholding Treatment ,Registries ,Morbidity ,Survival Rate ,Retrospective Studies ,Follow-Up Studies ,Aged ,Quality of Health Care ,Guideline Adherence ,United States ,Female ,Male ,Heart Failure ,Angiotensin Receptor Antagonists ,Outcome Assessment ,Health Care ,angiotensin II receptor blockers ,angiotensin‐converting enzyme inhibitors ,heart failure ,outcomes research ,quality of care ,angiotensin-converting enzyme inhibitors ,Clinical Research ,Cardiovascular ,Heart Disease ,Cardiorespiratory Medicine and Haematology - Abstract
BackgroundGuidelines recommend continuation or initiation of guideline-directed medical therapy, including angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARB), in hospitalized patients with heart failure with reduced ejection fraction.Methods and resultsUsing the Get With The Guidelines-Heart Failure Registry, we linked clinical data from 16 052 heart failure with reduced ejection fraction (ejection fraction ≤40%) patients with Medicare claims data. We divided ACEi/ARB-eligible patients into 4 categories based on admission and discharge ACEi/ARB use: continued (reference group), started, discontinued, or not started on therapy. A multivariable Cox proportional hazard model was used to determine the association between ACEi/ARB category and outcomes. Most, 90.5%, were discharged on ACEi/ARB (59.6% continued and 30.9% newly started). Of those discharged without ACEi/ARB, 1.9% were discontinued, and 7.5% were eligible but not started. Thirty-day mortality was 3.5% for patients continued and 4.1% for patients started on ACEi/ARB. In contrast, 30-day mortality was 8.8% for patients discontinued (adjusted hazard ratio [HRadj] 1.92; 95% CI 1.32-2.81; P
- Published
- 2017