Abstract 20456: Renin-Angiotensin System Inhibition and Reduction in All-Cause Mortality in Medicare Beneficiaries Hospitalized with Acute Diastolic Heart Failure: A Propensity-Matched Study of the OPTIMIZE-HF Registry
Background: Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) reduce mortality in systolic heart failure (HF). However, evidence of benefits of these drugs is unclear in HF patients with preserved ejection fraction (PEF). The objective of this study was to test the hypothesis that ACEI/ARB would reduce mortality in hospitalized older adults with acute decompensated HF-PEF enrolled into the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry.
Methods: Of the 6614 unique OPTIMIZE-HF patients hospitalized with acute decompensated HF-PEF (left ventricular EF ≥45%), linked with Medicare outcomes data, 3816 (58%) were prescribed ACEI or ARB at discharge Propensity for the receipt of discharge prescription for ACEI or ARB was estimated for each of the 6614 HF-PEF patients and was used to assemble a cohort of 2419 pairs of patients receiving and not receiving ACEI or ARB, who were balanced on 38 baseline characteristics. Matched Cox regression models were used to estimate association of ACEI or ARB use with all-cause mortality during ∼6 years of follow-up.
Results: Patients (n=4838) had a mean (±SD) age of 78 (±11) years, 64% were women, 11% were African American, and mean (±SD) EF was 0.58 (±0.09). All-cause mortality occurred in 70% and 72% of matched patients in the ACEI-ARB and no ACEI-ARB groups respectively (matched HR associated with ACEI or ARB use, 0.90; 95% CI, 0.83–0.98; p=0.014; Figure). The association was unchanged when we repeated the analysis using a multivariable Cox regression model adjusting for the same 38 variables among the 6614 pre-match patients (adjusted HR, 0.90; 95% CI, 0.85–0.96; p=0.001).
Conclusions: Discharge prescription of ACEI or ARB was associated with a modest yet statistically significant lower risk of all-cause mortality in Medicare beneficiaries hospitalized with acute decompensated HF-PSF.
- © 2010 by American Heart Association, Inc.