Abstract 4352: Closing the Treatment Gap in Heart Failure. Angiotensin Converting Enzyme Inhibitor Therapy in Patients with Renal Failure and Effect on Survival
Background: Heart failure (HF) clinical trials exclude subjects with renal failure (RF), and it is unclear if these patients can be treated as recommended by the guidelines. We sought to determine if poor outcomes is this population is due to RF or to the failure to receive recommended medications.
Methods: Retrospective analysis of 500 subjects admitted to Gundersen Lutheran HF disease management clinic from 4/99 to 1/03. RF was defined as serum creatinine ≥2.0 mg/dL. Data were collected annually for seven years. Endpoints were defined as all cause hospitalization and all cause death.
Results: Complete data was available on 449 subjects. Of these, 140 met criteria for RF and 309 had normal renal function. Subjects with RF were older (71±12 vs. 67±13 years, p=0.002) but had higher LVEF (26±9 vs. 23±10%, p=0.011). Subjects were followed for a median of 6.8 years. Overall, subjects with RF had worse outcomes for all cause death (p=0.001) and for all cause hospitalizations (p=0.001) compared to subjects without RF. Among subjects with RF, the success rate for treatment with ACEI/ARB was 90% (n=126). Subjects treated were classified as Group1, and those not tolerating treatment as Group 2. Death rates at one year were better among those treated (17% vs. 23 %). However, hospitalization rates at one year were similar (41% vs. 43%). KM analysis revealed significant group effect of ACEI/ARB outcomes (p=0.001).
Conclusion: 90% of subjects with RF were successfully treated and treatment was associated with better survival. This suggests that benefit of ACEI/ARB does extend to those with RF, and research is needed on mechanisms to apply the guidelines to subjects with RF.