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Int J Cardiol. 2018 Apr 15;257:168-176. doi: 10.1016/j.ijcard.2017.12.002.

Effects of angiotensin receptor blocker at discharge in patients with heart failure with reduced ejection fraction: Korean Acute Heart Failure (KorAHF) registry.

Author information

1
Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.
2
Sungkyunkwan University College of Medicine, Seoul, Republic of Korea. Electronic address: esjeon@skku.edu.
3
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
4
University of Ulsan College of Medicine, Seoul, Republic of Korea.
5
Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
6
Kyungpook National University College of Medicine, Daegu, Republic of Korea.
7
The Catholic University of Korea, Seoul, Republic of Korea.
8
Yonsei University College of Medicine, Seoul, Republic of Korea.
9
Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
10
Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
11
Heart Research Center of Chonnam National University, Gwangju, Republic of Korea.
12
National Institute of Health (NIH), Osong, Republic of Korea.

Abstract

BACKGROUND:

After introduction of up-titration strategy, there are limited data on comparison between the effects of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB) in patients with heart failure with reduced ejection fraction (HFrEF). The study sought to investigate the association between treatment with ARB at discharge and clinical outcomes in patients with HFrEF compared with treatment with ACEI or no renin angiotensin system blocker (RASB).

METHODS:

The KorAHF registry is a prospective multicenter cohort and included patients who were hospitalized for acute heart failure (AHF). We studied 3005 patients with HFrEF (<40%), and divided into ARB (n=1190), ACEI (n=1090), and no RASB (n=725) groups. Propensity score matching was performed.

RESULTS:

All-cause death occurred in 346 patients (29.1%) in the ARB group, 315 patients (28.9%) in the ACEI group, and 305 (42.1%) in the no RASB group. After propensity score matching (ARB vs. ACEI, 827 pairs), there was no significant difference between the two groups in the rate of death (HR 0.91, 95% CI 0.76-1.09, p=0.32). All-cause death was significantly lower in the ARB group than in the no RASB group (ARB vs. no RASB, 538 pairs, HR 0.69, 95% CI 0.56-0.83, p<0.001). The ARB group had a significantly lower discontinuation rate than the ACEI group (20.8% vs. 33.6%, p<0.001).

CONCLUSIONS:

For treatment of AHF with reduced EF after hospitalization, ARB at discharge shows a mortality benefit comparable to that of ACEI. In addition, tolerability of medication was greater for ARB than for ACEI.

KEYWORDS:

Angiotensin converting enzyme inhibitor; Angiotensin receptor blocker; Heart failure with reduced ejection fraction

PMID:
29506690
DOI:
10.1016/j.ijcard.2017.12.002
[Indexed for MEDLINE]

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