1. Discharge treatment with angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker after a heart failure hospitalisation is associated with a better prognosis irrespective of left ventricular ejection fraction.
- Author
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Vicent, Lourdes, Cinca, Juan, Vazquez‐García, Rafael, Gonzalez‐Juanatey, José R., Rivera, Miguel, Segovia, Javier, Pascual‐Figal, Domingo, Bover, Ramón, Worner, Fernando, Delgado‐Jiménez, Juan, Fernández‐Avilés, Francisco, and Martínez‐Sellés, Manuel
- Subjects
ACE inhibitors ,MORTALITY prevention ,MORTALITY risk factors ,CONFIDENCE intervals ,LEFT heart ventricle ,HEART physiology ,HEART failure ,HOSPITAL care ,HOSPITAL admission & discharge ,LONGITUDINAL method ,MEDICAL cooperation ,PATIENTS ,RESEARCH ,DISCHARGE planning ,ANGIOTENSIN receptors ,ODDS ratio ,VENTRICULAR ejection fraction - Abstract
Background: Medical therapy could improve the prognosis of real‐life patients discharged after a heart failure (HF) hospitalisation. Aim: 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 hospitalisation. Results: A total of 1831 patients was 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 with 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 + beta blocker + mineralocorticoid receptor antagonist) was associated with the lowest mortality risk (HR 0.21; 95% CI: 0.08–0.57, P = 0.002) compared with patients that received none of these drugs. Conclusions: Discharge treatment with ACE inhibitor/ARB after a HF hospitalisation is associated with a reduction in all‐cause and refractory HF mortality, irrespective of LVEF. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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