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.
Intern Med J
; 49(12): 1505-1513, 2019 12.
Article
em En
| MEDLINE
| ID: mdl-30887642
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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Inibidores da Enzima Conversora de Angiotensina
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Antagonistas de Receptores de Angiotensina
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Insuficiência Cardíaca
Tipo de estudo:
Clinical_trials
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article