Abstract
Background
After introduction of up-titration strategy, there are limited data on comparison
between the effects of angiotensin converting enzyme inhibitors (ACEI) and angiotensin
receptor blocker (ARB) in patients with heart failure with reduced ejection fraction
(HFrEF). The study sought to investigate the association between treatment with ARB
at discharge and clinical outcomes in patients with HFrEF compared with treatment
with ACEI or no renin angiotensin system blocker (RASB).
Methods
The KorAHF registry is a prospective multicenter cohort and included patients who
were hospitalized for acute heart failure (AHF). We studied 3005 patients with HFrEF
(<40%), and divided into ARB (n = 1190), ACEI (n = 1090), and no RASB (n = 725) groups. Propensity score matching was performed.
Results
All-cause death occurred in 346 patients (29.1%) in the ARB group, 315 patients (28.9%)
in the ACEI group, and 305 (42.1%) in the no RASB group. After propensity score matching
(ARB vs. ACEI, 827 pairs), there was no significant difference between the two groups
in the rate of death (HR 0.91, 95% CI 0.76–1.09, p = 0.32). All-cause death was significantly lower in the ARB group than in the no RASB
group (ARB vs. no RASB, 538 pairs, HR 0.69, 95% CI 0.56–0.83, p < 0.001). The ARB group had a significantly lower discontinuation rate than the ACEI
group (20.8% vs. 33.6%, p < 0.001).
Conclusions
For treatment of AHF with reduced EF after hospitalization, ARB at discharge shows
a mortality benefit comparable to that of ACEI. In addition, tolerability of medication
was greater for ARB than for ACEI.
Abbreviations:
ACEI (angiotensin converting enzyme inhibitor), AHF (acute heart failure), ARB (angiotensin receptor blocker), ARNI (angiotensin receptor-neprilysin inhibitor), CKD (chronic kidney disease), GFR (glomerular filtration rate), HFpEF (heart failure with preserved ejection fraction), HFrEF (heart failure with reduced ejection fraction), LVEF (left ventricular ejection fraction), RASB (renin angiotensin system blocker)Keywords
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Article info
Publication history
Accepted:
December 1,
2017
Received in revised form:
October 4,
2017
Received:
June 19,
2017
Footnotes
☆Trial registration: KorAHF registry, ClinicalTrial.gov, NCT01389843.
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Analysing registries in heart failure: The case of angiotensin receptor blockers in Asians with heart failure with reduced ejection fractionInternational Journal of CardiologyVol. 257
- PreviewAngiotensin converting enzyme (ACE) inhibitors remain the foundation of treatment for heart failure with reduced ejection fraction (HFREF) [1]. Angiotensin receptor blockers (ARB) are recommended as an alternative if the patient cannot tolerate an ACE inhibitor as a result of the findings of the CHARM-Alternative trial [2]. In many Asian countries ARBs are given as a first line drug, rather than ACE inhibitors, as many Asian patients fail to tolerate ACE inhibitors due to cough [3]. The reason for this racial disparity in the incidence of ACE inhibitor induced cough is not fully understood.
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