1. Renin-Angiotensin System Inhibition and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries with Heart Failure.
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Sanam, Kumar, Bhatia, Vikas, Bajaj, Navkaranbir S., Gaba, Saurabh, Morgan, Charity J., Fonarow, Gregg C., Butler, Javed, Deedwania, Prakash, Prabhu, Sumanth D., Wu, Wen-Chih, White, Michel, Love, Thomas E., Aronow, Wilbert S., Fletcher, Ross D., Allman, Richard M., and Ahmed, Ali
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RENIN-angiotensin system , *PATIENT readmissions , *HEART failure treatment , *HEART failure patients , *ACE inhibitors , *ANGIOTENSIN receptors , *HEART ventricle diseases , *CAUSES of death , *LEFT heart ventricle , *HEART failure , *HOSPITAL care , *MEDICARE , *MORTALITY , *PROBABILITY theory , *RESEARCH funding , *PROPORTIONAL hazards models , *STROKE volume (Cardiac output) , *THERAPEUTICS ,PATIENT Protection & Affordable Care Act - Abstract
Background: Heart failure is the leading cause for 30-day all-cause readmission, the reduction of which is a goal of the Affordable Care Act. There is a growing interest in understanding the impact of evidence-based heart failure therapy on 30-day all-cause readmission. In the current study, we examined the impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI-ARBs) on 30-day all-cause readmission in heart failure.Methods: Of the 1384 hospitalized Medicare beneficiaries with heart failure and left ventricular ejection fraction <45% discharged alive from 106 Alabama hospitals (1998-2001) without prior ACEI-ARB use and without known contraindications to ACEI-ARB use; 734 received new predischarge prescriptions for these drugs. Using propensity scores for ACEI-ARB initiation, we assembled a matched cohort of 477 pairs of patients balanced on 32 baseline characteristics (mean age 75 years, 46% women, 26% African American).Results: Thirty-day all-cause readmissions occurred in 18% and 24% of matched patients receiving and not receiving ACEI-ARBs, respectively (hazard ratio [HR] 0.74; 95% confidence interval [CI], 0.56-0.97; P = .030). ACEI-ARB use was also associated with lower risk of 30-day all-cause mortality (HR 0.56; 95% CI, 0.33-0.98; P = .041) and of the combined endpoint of 30-day all-cause readmission or 30-day all-cause mortality (HR 0.73; 95% CI, 0.56-0.94; P = .017). All associations remained significant at 1 year post discharge.Conclusions: Among hospitalized patients with heart failure and reduced ejection fraction, the use of ACEI-ARBs was associated with a significantly lower risk of 30-day all-cause readmission and 30-day all-cause mortality; both beneficial associations persisted during long-term follow-up. [ABSTRACT FROM AUTHOR]- Published
- 2016
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