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Cited by 169Heart Failure Treatment and ManagementHeart rate and cardiovascular healthBlood Pressure and Hypertension Studies

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

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Gilstrap, Lauren G., Fonarow, Gregg C., Desai, Akshay S., Liang, Li, Matsouaka, Roland, DeVore, Adam D., Smith, Eric E., Heidenreich, Paul +3 more·2017·Journal of the American Heart Association
DOI 10.1161/jaha.116.004675PMC PMC5523765
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Abstract

Background: Guidelines recommend continuation or initiation of guideline‐directed medical therapy, including angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers ( ACE i/ ARB ), in hospitalized patients with heart failure with reduced ejection fraction. Methods and Results: Using the Get With The Guidelines‐Heart Failure Registry, we linked clinical data from 16 052 heart failure with reduced ejection fraction (ejection fraction ≤40%) patients with Medicare claims data. We divided ACE i/ ARB ‐eligible patients into 4 categories based on admission and discharge ACE i/ ARB use: continued (reference group), started, discontinued, or not started on therapy. A multivariable Cox proportional hazard model was used to determine the association between ACE i/ ARB category and outcomes. Most, 90.5%, were discharged on ACE i/ ARB (59.6% continued and 30.9% newly started). Of those discharged without ACE i/ ARB , 1.9% were discontinued, and 7.5% were eligible but not started. Thirty‐day mortality was 3.5% for patients continued and 4.1% for patients started on ACE i/ ARB . In contrast, 30‐day mortality was 8.8% for patients discontinued (adjusted hazard ratio [ HR adj ] 1.92; 95% CI 1.32‐2.81; P <0.001) and 7.5% for patients not started ( HR adj 1.50; 95% CI 1.12‐2.00; P =0.006). The 30‐day readmission rate was lowest among patients continued or started on therapy. One‐year mortality was 28.2% for patients continued and 29.7% for patients started on ACE i/ ARB compared to 41.6% for patients discontinued ( HR adj 1.35; 95% CI 1.13‐1.61; P <0.001) and 41.7% ( HR adj 1.28; 95% CI 1.14‐1.43; P <0.001) for patients not started on therapy. Conclusions: Compared with continuation, withdrawal of ACE i/ ARB during heart failure hospitalization is associated with higher rates of postdischarge mortality and readmission, even after adjustment for severity of illness.

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Authors
Gilstrap, L. G., Fonarow, G. C., Desai, A. S., Liang, L., Matsouaka, R., DeVore, A. D., Smith, E. E., Heidenreich, P., Hernandez, A. F., Yancy, C. W., & Bhatt, D. L.
Affiliations
  • Brigham and Women's Hospital (US)
  • University of California, Los Angeles (US)
  • Duke University (US)
  • University of Calgary (CA)
  • VA Palo Alto Health Care System (US)
  • Northwestern University (US)
Corresponding author
Bhatt, Deepak L.
ORCID
Venue
Journal of the American Heart Association
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017-02-02
Volume
6
Issue
2
ISSN
2047-9980 (ISSN-L)
DOI
10.1161/jaha.116.004675
PMC
PMC5523765
OpenAlex
W2800798998
Cited by
169
References
3
Citations by year
2026: 10 · 2025: 17 · 2024: 20 · 2023: 20 · 2022: 24 · 2021: 14 · 2020: 30 · 2019: 14 · 2018: 16 · 2017: 4
FWCI
13.55
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • DukeSpace (Duke University) (submittedVersion, cc-by-nc-nd)
  • eScholarship (California Digital Library) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
ACE inhibitors, angiotensin receptor blockers, heart failure with reduced ejection fraction, guideline-directed medical therapy, drug discontinuation, 30-day mortality, heart failure readmission, one-year mortality, hospitalized heart failure patients, Medicare claims data
MeSH terms
Aged, Angiotensin-Converting Enzyme Inhibitors, Female, Follow-Up Studies, Heart Failure, Hospitalization, Humans, Male, Morbidity, Patient Readmission, Quality of Health Care, Registries, Retrospective Studies, Stroke Volume, United States, Survival Rate, Outcome Assessment, Health Care, Guideline Adherence, Withholding Treatment, Angiotensin Receptor Antagonists

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