Clinical research studyAngiotensin-converting Enzyme Inhibitors and Outcomes in Heart Failure and Preserved Ejection Fraction
Section snippets
Data Sources and Study Population
The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) is a national registry of hospitalized patients with heart failure and has been well described in the literature.20, 21, 22 Briefly, charts from 48,612 hospitalizations due to heart failure occurring in 259 hospitals from 48 states between March 2003 and December 2004 were abstracted by trained staff.20 A primary discharge diagnosis of heart failure was determined on the basis of the
Baseline Characteristics
Matched patients (n = 2674) had a mean (± standard deviation) age of 81 (±8) years and mean (± standard deviation) left ventricular ejection fraction of 55% (±9), 63% were women, and 9% were African American. Before matching, patients receiving a new prescription for ACE inhibitors were more likely to be symptomatic but had a lower prevalence of comorbidities, such as atrial fibrillation and chronic kidney disease. These and other pre-match imbalances were balanced after matching (Table 1,
Discussion
Findings from our study demonstrate that a new discharge prescription for ACE inhibitors was associated with a statistically significant modest 9% lower risk of the composite end point of all-cause mortality or heart failure hospitalization in a wide spectrum of propensity-matched older patients with heart failure and preserved ejection fraction who were balanced on more than 100 potential confounders. Similar multivariable-adjusted or propensity-adjusted associations were observed when
Conclusions
In hospitalized older patients with heart failure and preserved ejection fraction who were not receiving angiotensin receptor blockers, a new discharge prescription for ACE inhibitors was associated with a modest improvement in the composite end point of total mortality or heart failure hospitalization but had no association with the individual components of mortality and heart failure hospitalization. Findings from this rigorously conducted propensity-matched inception cohort study need to be
References (48)
- et al.
Outcomes in ambulatory chronic systolic and diastolic heart failure: a propensity score analysis
Am Heart J
(2006) - et al.
Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry
J Am Coll Cardiol
(2007) - et al.
Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial
Lancet
(2003) - et al.
Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial
Lancet
(2003) - et al.
Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF): rationale and design
Am Heart J
(2004) - et al.
Linking inpatient clinical registry data to Medicare claims data using indirect identifiers
Am Heart J
(2009) - et al.
Renin-angiotensin inhibition in systolic heart failure and chronic kidney disease
Am J Med
(2012) - et al.
Renin-angiotensin inhibition in diastolic heart failure and chronic kidney disease
Am J Med
(2013) - et al.
Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores
J Clin Epidemiol
(2001) - et al.
A propensity-matched study of the association of peripheral arterial disease with cardiovascular outcomes in community-dwelling older adults
Am J Cardiol
(2009)
Association between hyperuricemia and incident heart failure among older adults: a propensity-matched study
Int J Cardiol
A propensity-matched study of outcomes of chronic heart failure (HF) in younger and older adults
Arch Gerontol Geriatr
Impact of renin-angiotensin system blockade therapy on outcome in aortic stenosis
J Am Coll Cardiol
Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge
J Am Coll Cardiol
Heart disease and stroke statistics—2011 update: a report from the American Heart Association
Circulation
Effects of enalapril on mortality in severe congestive heart failureResults of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS)
N Engl J Med
Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure
N Engl J Med
Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failureCollaborative Group on ACE Inhibitor Trials
JAMA
A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure
N Engl J Med
2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation
Circulation
Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure
JAMA
Irbesartan in patients with heart failure and preserved ejection fraction
N Engl J Med
The perindopril in elderly people with chronic heart failure (PEP-CHF) study
Eur Heart J
The central role of propensity score in observational studies for causal effects
Biometrika
Cited by (36)
Blockade of the neurohormonal systems in heart failure with preserved ejection fraction: A contemporary meta-analysis
2020, International Journal of CardiologyCitation Excerpt :Eleven studies consisting of 27,170 patients, among whom 13,756 in the treatment and 13,504 in the control groups, reported data about hospitalizations for HF [20–28,30,31]. One study was performed with ARNi [20], 3 studies were with ARBs [21,23,26],3 with ACEi [24,27,31], 3 used both ACEi and ARBs [28–30], 2 were conducted with MRA [22,25]. Six were randomized clinical trials and 6 were observational studies (4 with propensity score analysis) [26–31].
Digoxin Initiation and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction
2020, American Journal of MedicineDigoxin Discontinuation and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction
2019, Journal of the American College of Cardiology2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure
2017, Canadian Journal of CardiologyCitation Excerpt :Similarly, frailty affects up to 50% of older patients with HF, in whom it is associated with nonspecific clinical features, acute care utilization, poor quality of life, worse outcomes from concomitant conditions, and mortality.568 Recommendations regarding HF therapy apply to older patients and should not be restricted on the basis of age alone.180,182,569-576 Frail patients are vulnerable to side effects due to the polypharmacy inherent to the treatment of HF and other comorbidities.
Digoxin and 30-Day All-Cause Readmission in Long-Term Care Residents Hospitalized for Heart Failure
2017, Journal of the American Medical Directors AssociationCitation Excerpt :Propensity scores for the receipt of digoxin use were estimated for each of the 545 patients using a nonparsimonious multivariable logistic regression model in which the receipt of digoxin was the dependent variable and 29 baseline characteristics were used as covariates.12–14 Using a greedy matching protocol described elsewhere,15 we assembled a matched cohort of 158 pairs of patients receiving and not receiving digoxin. To estimate if the 29 baseline characteristics used in the propensity score model were sufficiently balanced between the 2 groups, we estimated absolute standardized differences for all those variables.16
Diagnosis and Management of Heart Failure in Older Adults
2017, Heart Failure Clinics
Funding: The project described was supported by Grant R01-HL097047 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NIH) (Principal Investigator: Dr Ahmed). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Heart, Lung, and Blood Institute or NIH. Dr Ahmed also is supported by a generous gift from Jean B. Morris of Birmingham, Alabama. Dr Allman is supported by NIH/National Center for Research Resources Grant 5UL1 RR025777. OPTIMIZE-HF was funded by GlaxoSmithKline (Principal Investigator: Dr Fonarow).
Conflict of Interest: None.
Authorship: AA conceived the study hypothesis and design in collaboration with coauthors. AA and MM wrote the first draft. AA, MM, KP and YZ performed statistical analyses in collaboration with IBA and TEL. All authors interpreted the data, participated in critical revision of the manuscript for important intellectual contents, and approved the final version of the article. IBA, AA, MM, KP, and YZ had full access to the data.