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Renin-Angiotensin Inhibition and Outcomes in HFrEF and Advanced Kidney Disease. | LitMetric

AI Article Synopsis

  • Renin-angiotensin system inhibitors can enhance outcomes for patients with heart failure and reduced ejection fraction (HFrEF), but their effectiveness in those with advanced kidney disease was less understood.
  • In a study involving 1,582 patients with HFrEF and severe kidney issues, researchers analyzed the effects of starting ACE inhibitors or ARBs on patient outcomes.
  • The results indicated that patients who started these medications experienced better outcomes regarding heart failure readmissions and overall mortality, suggesting that these drugs may be beneficial for this specific patient group.

Article Abstract

Background: Renin-angiotensin system inhibitors improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, less is known about their effectiveness in patients with HFrEF and advanced kidney disease.

Methods: In the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF), 1582 patients with HFrEF (ejection fraction ≤40%) had advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m). Of these, 829 were not receiving angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) prior to admission, of whom 214 were initiated on these drugs prior to discharge. We calculated propensity scores for receipt of these drugs for each of the 829 patients and assembled a matched cohort of 388 patients, balanced on 47 baseline characteristics (mean age 78 years; 52% women; 10% African American; 73% receiving beta-blockers). Hazard ratios (HR) and 95% confidence intervals (CI) were estimated comparing 2-year outcomes in 194 patients initiated on ACE inhibitors or ARBs to 194 patients not initiated on those drugs.

Results: The combined endpoint of heart failure readmission or all-cause mortality occurred in 79% and 84% of patients initiated and not initiated on ACE inhibitors or ARBs, respectively (HR associated with initiation, 0.79; 95% CI, 0.63-0.98). Respective HRs (95% CI) for the individual endpoints of - Respective HRs (95% CI) for the individual endpoints of all-cause mortality and heart failure readmission were 0.81 (0.63-1.03) and 0.63 (0.47-0.85).

Conclusions: The findings from our study add new information to the body of cumulative evidence that suggest that renin-angiotensin system inhibitors may improve clinical outcomes in patients with HFrEF and advanced kidney disease. These hypothesis-generating findings need to be replicated in contemporary patients.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10466279PMC
http://dx.doi.org/10.1016/j.amjmed.2023.03.017DOI Listing

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