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Vicent L, Cinca J, Vazquez-García R, Gonzalez-Juanatey JR, Rivera M, Segovia J, Pascual-Figal D, Bover R, Worner F, Delgado-Jiménez J, Fernández-Avilés F, Martínez-Sellés M. 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 2020; 49:1505-1513. [PMID: 30887642 DOI: 10.1111/imj.14289] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/18/2019] [Accepted: 03/05/2019] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain
| | | | | | - Miguel Rivera
- Cardiology Department, University Hospital La Fe, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Fernando Worner
- Cardiology Department, Hospital Universitari Arnau de Vilanova, Lleida, IRBLLEIDA, Spain
| | | | - Francisco Fernández-Avilés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Cardiology Department, Universidad Complutense, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Cardiology Department, Universidad Complutense, Madrid, Spain.,Universidad Europea, Madrid, Spain
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