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

• Published in: Internal medicine journal 2019-12, Vol.49 (12), p.1505-1513
• Main Authors: 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, Martínez‐Sellés, Manuel
• Format: Article
• Language: English
• Subjects: ACE inhibitors; Aged; Aged, 80 and over; Angiotensin II; angiotensin II receptor blocker; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-converting enzyme inhibitors; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; angiotensin‐converting enzyme inhibitor; Congestive heart failure; Drug Therapy, Combination; Ejection fraction; Enzymes; Female; Heart failure; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - physiopathology; heart failure readmission; Humans; Logistic Models; Male; Middle Aged; Mortality; Multivariate Analysis; Patient Discharge; Patients; Prognosis; Prospective Studies; Registries; Spain - epidemiology; Stroke Volume - drug effects; Survival Analysis; Ventricle; Ventricular Function, Left - drug effects
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.14289

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.