Author + information
- Michael Chiua,b,
- Robert J.H. Millera,b,
- Bing Lia,b,
- Stephen Wiltona,b,
- Merril Knudtsona,b,
- Jonathan Howletta,b and
- Mathew T. Jamesa,b
Background: Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) improve outcomes in systolic heart failure (HF). However, the patterns of use of these medications and their relationship with outcomes in patients with HF and kidney dysfunction are unclear.
Methods: We performed a cohort study to characterize the association between estimated glomerular filtration rate (eGFR), ACE-I or ARB use, and survival among 1404 patients discharged after hospitalization for HF from 4 sites between 2008 and 2012. Outpatient prescriptions and mortality were ascertained from provincial administrative databases. Adjusted survival models were used to evaluate the association between ACE-I or ARB use and all-cause mortality, and to determine whether kidney function was a modifier of this association.
Results: Compared to patients with normal kidney function, those with reduced eGFR had significantly lower rates of ACE-I or ARB use in the first 3 months following hospital discharge; 71, 67, 62, and 52% for those with eGFR>90, 45-89, 30-44, and <30 mL/min/1.73m2, respectively. In adjusted Cox regression models, ACE-I/ARB use following discharge was associated with 25% lower hazard of death (HR 0.75, 95%CI 0.61-0.92), without evidence that this association differed by eGFR (p-interaction 0.753).
Conclusions: Patients with reduced eGFR were less likely to receive ACE-I/ARB following HF hospitalization. However, these medications were associated with lower mortality regardless of kidney function. Further research is needed on the effects of continuing versus withdrawing ACEI or ARB in patients with acutely decompensated HF and kidney dysfunction.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Heart Failure: Evaluating Strategies to Prevent Readmissions
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1163-273
- 2017 American College of Cardiology Foundation