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Abstract: TH-PO603

Association Between ACEI/ARB Use With Mortality, Heart Failure Admissions, and Kidney Failure Outcomes Among Patients Admitted for Acute Heart Failure Requiring Invasive Hemodynamic Monitoring

Session Information

Category: Hypertension and CVD

  • 1501 Hypertension and CVD: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Tuttle, Marcelle, Tufts Medical Center, Boston, Massachusetts, United States
  • Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States
  • Gillberg, Jake, Tufts Medical Center, Boston, Massachusetts, United States
  • Banlengchit, Run, Tufts Medical Center, Boston, Massachusetts, United States
  • Oka, Tatsufumi, Tufts Medical Center, Boston, Massachusetts, United States
  • Testani, Jeffrey M., Yale School of Medicine, New Haven, Connecticut, United States
  • Kiernan, Michael S., Tufts Medical Center, Boston, Massachusetts, United States
  • Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States
  • McCallum, Wendy I., Tufts Medical Center, Boston, Massachusetts, United States
Background

Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARB) are recommended for patients with heart failure. However, frequently ACEI/ARBs are discontinued or never started during hospitalizations for acute heart failure (AHF), despite evidence of their cardio- and renal-protective benefit.

Methods

Records for patients admitted to a quaternary academic center for AHF from 2015-2021 requiring hemodynamic monitoring were reviewed. Definitions included those who continued (ACEI/ARB on the admission and discharge list), started (ACEI/ARB on discharge list only), discontinued (ACEI/ARB on admission list only), or never started. Multivariable Cox regression models were used to examine the association of ACEI/ARB use with a composite outcome of death or AHF readmission and kidney failure (KF) requiring renal replacement therapy.

Results

We identified 727 patients admitted for AHF requiring hemodynamic monitoring and surviving to discharge. Mean (SD) age was 61 (14) years and eGFR was 57 (27) ml/min/1.73m2. 32% continued, 10% started, 20% discontinued and 38% never started ACEI/ARBs. Over a median follow-up of 5.7 months, compared to patients who continued on ACEI/ARBs, those who either stopped or never started ACEI/ARBs had higher risk of death or AHF hospitalization (Table). KF event numbers were small (n=54) but with similar trends not reaching statistical significance.

Conclusion

Among patients admitted for AHF requiring invasive hemodynamic monitoring, patients who were discontinued or never started on ACEI/ARB had an increased risk of death and heart failure hospitalization. Either this supports the importance of ACEI/ARB benefit in this high acuity AHF cohort, or the inability to tolerate RAAS inhibition is a powerful prognostic factor.

Funding

  • Other NIH Support