Renin-angiotensin system inhibition and lower 30-day all-cause readmission in Medicare beneficiaries with heart failure
Open accessAbstract
Background Heart failure is the leading cause for 30-day all-cause readmission, the reduction of which is a goal of the Affordable Care Act. There is a growing interest in understanding the impact of evidence-based heart failure therapy on 30-day all-cause readmission. In the current study, we examined the impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI-ARBs) on 30-day all-cause readmission in heart failure.Methods Of the 1384 hospitalized Medicare beneficiaries with heart failure and left ventricular ejection fraction <45% discharged alive from 106 Alabama hospitals (1998-2001) without prior ACEI-ARB use and without known contraindications to ACEI-ARB use; 734 received new predischarge prescriptions for these drugs. Using propensity scores for ACEI-ARB initiation, we assembled a matched cohort of 477 pairs of patients balanced on 32 baseline characteristics (mean age 75 years, 46% women, 26% African American).Results Thirty-day all-cause readmissions occurred in 18% and 24% of matched patients receiving and not receiving ACEI-ARBs, respectively (hazard ratio [HR] 0.74; 95% confidence interval [CI], 0.56-0.97; P = .030). ACEI-ARB use was also associated with lower risk of 30-day all-cause mortality (HR 0.56; 95% CI, 0.33-0.98; P = .041) and of the combined endpoint of 30-day all-cause readmission or 30-day all-cause mortality (HR 0.73; 95% CI, 0.56-0.94; P = .017). All associations remained significant at 1 year post discharge.Conclusions Among hospitalized patients with heart failure and reduced ejection fraction, the use of ACEI-ARBs was associated with a significantly lower risk of 30-day all-cause readmission and 30-day all-cause mortality; both beneficial associations persisted during long-term follow-up.
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In a matched-cohort analysis of Medicare beneficiaries hospitalized for HF between 1998 and 2001, patients who initiated ACEI/ARB treatment had lower 30-day readmission rates (18% vs 24%) and all-cause mortality (7% vs 14%) compared with those for whom ACEI/ARB treatment was discontinued.
“A matched-cohort analysis of Medicare beneficiaries hospitalized for HF between 1998 and 2001 showed that patients who initiated ACEI/ARB treatment had lower 30-day readmission rates (18% vs 24%) and all-cause mortality (7% vs 14%) compared with those for whom ACEI/ARB treatment was discontinued.18”
From CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction (2021) · cites this paper as [18]
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- Authors
- Sanam, K., Bhatia, V., Bajaj, N. S., Gaba, S., Morgan, C. J., Fonarow, G. C., Butler, J., Deedwania, P., Prabhu, S. D., Wu, W.-C., White, M., Love, T. E., Aronow, W. S., Fletcher, R. D., Allman, R. M., & Ahmed, A.
- Affiliations
- Ascension (US)
- University of Alabama at Birmingham (US)
- University of California, Los Angeles (US)
- Stony Brook University (US)
- University of California, San Francisco (US)
- Providence VA Medical Center (US)
- Montreal Heart Institute (CA)
- Case Western Reserve University (US)
- New York Medical College (US)
- Veterans Health Administration (US)
- United States Department of Veterans Affairs (US)
- Corresponding author
- Ahmed, Ali
- ORCID
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2016-10
- Volume
- 129
- Issue
- 10
- Pages
- 1067-1073
- ISSN
- 0002-9343 (ISSN-L)
- PMC
- PMC5039055
- OpenAlex
- W2410085111
- Cited by
- 50
- References
- 25
- Citations by year
- 2025: 2 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 6 · 2020: 7 · 2019: 5 · 2018: 11 · 2017: 3 · 2016: 1
- FWCI
- 5.50
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (K23AG019211)
- National Heart, Lung, and Blood Institute (R01HL097047, R01HL085561)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- heart failure, renin-angiotensin system blockade, ACE inhibitors, angiotensin receptor blockers, 30-day readmission, all-cause mortality, reduced ejection fraction, Medicare beneficiaries, post-discharge outcomes, evidence-based treatment
- MeSH terms
- Aged, Aged, 80 and over, Alabama, Angiotensin-Converting Enzyme Inhibitors, Cause of Death, Female, Medicare, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Mortality, Patient Readmission, Renin-Angiotensin System, Stroke Volume, United States, Proportional Hazards Models, Ventricular Dysfunction, Left, Angiotensin Receptor Antagonists, Protective Factors
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