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 FractionLiterature - Gilstrap LG, Fonarow GC, Desai AS, et al. - J Am Heart Assoc. 2017;6:e004675
- 90.5% of patients were discharged on ACEi/ARB, of whom 59.6% continued and 30.9% newly started ACEi/ARB, 1.9% discontinued ACEi/ARB therapy, and 7.5% were not started.
- Patients who discontinued or did not start ACEi/ARB therapy, had higher rates of renal dysfunction, and lower rates of being provided discharge instructions, smoking cessation counselling, timely follow-up appointments, and ICD counselling.
- The adjusted HR for 30-day mortality in patients who discontinued ACEi/ARB therapy was 1.92 (95% CI: 1.32-2.81; P<0.001) compared to patients who continued therapy. For patients who did not start therapy, the adjusted HR for 30-day mortality was 1.50 (95% CI: 1.12-2.06; P=0.006).
- The adjusted HR for 1-year mortality of patients discontinued from ACEi/ARB therapy was 1.35 (95% CI: 1.13-1.61; P=0.001), and for those not started on ACEi/ARB the adjusted HR was 1.28 (95% CI: 1.14-1.43; P<0.001).
- The adjusted HR for 30-day readmission was 1.40 (95% CI: 1.16-1.71; P<0.001) among those who discontinued compared with patients who continued or started on ACEi/ARB and 1.14 (95% CI: 1.01-1.29; P=0.038) among those who did not start ACEi/ARB.
- At 90 days, after adjustment, there was no difference in readmission rates between the groups.
- The findings regarding the composite endpoint of mortality and readmission were similar to the mortality and readmission rates described above.
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.