Physicians' Academy for Cardiovascular Education

ACEi/ARB therapy at discharge associated with lower mortality and readmission rates in HFrEF

Initiation, Continuation, or Withdrawal of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

Literature - Gilstrap LG, Fonarow GC, Desai AS, et al. - J Am Heart Assoc. 2017;6:e004675


Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) improve symptoms, reduce hospitalisations, and improve survival in heart failure (HF) patients with reduced ejection fraction (HFrEF), and are recommended by guidelines at discharge for the prevention of symptomatic HF in these patients [1-5]. However, the impact of continuing or discontinuing ACEi/ARB after hospitalisation for acute decompensated heart failure (ADHF) has not been thoroughly evaluated.

In this study, the relationship between the continuation or withdrawal of ACEi/ARB therapy and outcomes was assessed, in 16 052 HFrEF patients hospitalised for ADHF. Data of the Get With The Guidelines Heart Failure (GWTG-HF) registry linked with Medicare inpatient data were used for these analyses.

Main results


In a large cohort of 16 052 HFrEF patients, the continuation or initiation of ACEi/ARB therapy at the time of discharge after admission for ADHF was associated with lower mortality and readmission rates, compared with those who discontinued or did not start therapy. These findings provide further evidence related to guideline recommendations for these patients.


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