期刊
CARDIORENAL MEDICINE
卷 11, 期 5-6, 页码 226-236出版社
KARGER
DOI: 10.1159/000519014
关键词
Angiotensin-converting enzyme inhibitors; Angiotensin receptor blockers; Acute heart failure; Readmissions; Mortality; Outcomes
资金
- University of South Carolina School of Medicine Research Center for Transforming Health Emerging Physician Scientist Program
The study revealed that changes in kidney function at admission have a significant impact on the utilization of ACEI/ARB in patients with acute heart failure, and that discharge with ACEI/ARB is associated with lower mortality rates for these patients.
Objective: The aim of the study was to determine patterns and predictors of utilization of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) in patients with acute heart failure (AHF) and changes in kidney function at admission, hospitalization, and discharge in relation to clinical outcomes. Methods: This retrospective analysis of the Veterans' Health Administration data (2016) included patients with heart failure (HF) with reduced ejection fraction who were hospitalized. Patients with an estimated glomerular filtration <15 cm(3) /min/1.73 m(2) and those on dialysis were excluded. Patients were categorized based on the use of ACEI/ARB as continued, initiated, discontinued, or no therapy. Multivariable logistic regression evaluated predictors of being discharged home on an ACEI/ARB. Cox regression analysis evaluated outcomes (30 and 180-day mortality/HF readmissions). Results: 3,652 patients were included, of which 37% of patients hospitalized for AHF had ACEI/ARB discontinued on admission, or not initiated. After adjusting for age, blood pressure, and serum potassium, a per-unit increase in admission serum creatinine (SCr) was independently associated with lower rates of continuation or initiation of ACEI/ARB odds ratio 0.51 95% confidence interval (CI) (0.46-0.57). Discharge on ACEI/ARB was independently associated with lower odds of 30- and 180-day mortality hazard ratio (HR) 0.36 95% CI (0.25-0.52), and HR 0.23 95% CI (0.19-0.27), respectively. Conclusion: Higher SCr at admission is an important determinant of ACEI/ARB being discontinued or withheld in patients admitted with AHF. ACEI/ARB at discharge was associated with lower mortality in patients with AHF. (C) 2021 The Author(s).
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