Effects of angiotensin receptor blocker at discharge in patients with heart failure with reduced ejection fraction

Korean Acute Heart Failure (KorAHF) registry

Ki Hong Choi, Ga Yeon Lee, Jin Oh Choi, Eun Seok Jeon, Hae Young Lee, Hyun Jai Cho, Sang Eun Lee, Min Seok Kim, Jae Joong Kim, Kyung Kuk Hwang, Shung Chull Chae, Sang Hong Baek, seokmin kang, Dong Ju Choi, Byungsu Yoo, Kye Hun Kim, Hyun Young Park, Myeong Chan Cho, Byung Hee Oh

Research output: Contribution to journalArticle

Abstract

Background: After introduction of up-titration strategy, there are limited data on comparison between the effects of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB) in patients with heart failure with reduced ejection fraction (HFrEF). The study sought to investigate the association between treatment with ARB at discharge and clinical outcomes in patients with HFrEF compared with treatment with ACEI or no renin angiotensin system blocker (RASB). Methods: The KorAHF registry is a prospective multicenter cohort and included patients who were hospitalized for acute heart failure (AHF). We studied 3005 patients with HFrEF (< 40%), and divided into ARB (n = 1190), ACEI (n = 1090), and no RASB (n = 725) groups. Propensity score matching was performed. Results: All-cause death occurred in 346 patients (29.1%) in the ARB group, 315 patients (28.9%) in the ACEI group, and 305 (42.1%) in the no RASB group. After propensity score matching (ARB vs. ACEI, 827 pairs), there was no significant difference between the two groups in the rate of death (HR 0.91, 95% CI 0.76–1.09, p = 0.32). All-cause death was significantly lower in the ARB group than in the no RASB group (ARB vs. no RASB, 538 pairs, HR 0.69, 95% CI 0.56–0.83, p < 0.001). The ARB group had a significantly lower discontinuation rate than the ACEI group (20.8% vs. 33.6%, p < 0.001). Conclusions: For treatment of AHF with reduced EF after hospitalization, ARB at discharge shows a mortality benefit comparable to that of ACEI. In addition, tolerability of medication was greater for ARB than for ACEI.

Original languageEnglish
Pages (from-to)168-176
Number of pages9
JournalInternational Journal of Cardiology
Volume257
DOIs
Publication statusPublished - 2018 Apr 15

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Patient Discharge
Angiotensin Receptor Antagonists
Registries
Angiotensin-Converting Enzyme Inhibitors
Heart Failure
Renin-Angiotensin System
Propensity Score
Cause of Death
Mortality
Hospitalization
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Choi, Ki Hong ; Lee, Ga Yeon ; Choi, Jin Oh ; Jeon, Eun Seok ; Lee, Hae Young ; Cho, Hyun Jai ; Lee, Sang Eun ; Kim, Min Seok ; Kim, Jae Joong ; Hwang, Kyung Kuk ; Chae, Shung Chull ; Baek, Sang Hong ; kang, seokmin ; Choi, Dong Ju ; Yoo, Byungsu ; Kim, Kye Hun ; Park, Hyun Young ; Cho, Myeong Chan ; Oh, Byung Hee. / Effects of angiotensin receptor blocker at discharge in patients with heart failure with reduced ejection fraction : Korean Acute Heart Failure (KorAHF) registry. In: International Journal of Cardiology. 2018 ; Vol. 257. pp. 168-176.
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title = "Effects of angiotensin receptor blocker at discharge in patients with heart failure with reduced ejection fraction: Korean Acute Heart Failure (KorAHF) registry",
abstract = "Background: After introduction of up-titration strategy, there are limited data on comparison between the effects of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB) in patients with heart failure with reduced ejection fraction (HFrEF). The study sought to investigate the association between treatment with ARB at discharge and clinical outcomes in patients with HFrEF compared with treatment with ACEI or no renin angiotensin system blocker (RASB). Methods: The KorAHF registry is a prospective multicenter cohort and included patients who were hospitalized for acute heart failure (AHF). We studied 3005 patients with HFrEF (< 40{\%}), and divided into ARB (n = 1190), ACEI (n = 1090), and no RASB (n = 725) groups. Propensity score matching was performed. Results: All-cause death occurred in 346 patients (29.1{\%}) in the ARB group, 315 patients (28.9{\%}) in the ACEI group, and 305 (42.1{\%}) in the no RASB group. After propensity score matching (ARB vs. ACEI, 827 pairs), there was no significant difference between the two groups in the rate of death (HR 0.91, 95{\%} CI 0.76–1.09, p = 0.32). All-cause death was significantly lower in the ARB group than in the no RASB group (ARB vs. no RASB, 538 pairs, HR 0.69, 95{\%} CI 0.56–0.83, p < 0.001). The ARB group had a significantly lower discontinuation rate than the ACEI group (20.8{\%} vs. 33.6{\%}, p < 0.001). Conclusions: For treatment of AHF with reduced EF after hospitalization, ARB at discharge shows a mortality benefit comparable to that of ACEI. In addition, tolerability of medication was greater for ARB than for ACEI.",
author = "Choi, {Ki Hong} and Lee, {Ga Yeon} and Choi, {Jin Oh} and Jeon, {Eun Seok} and Lee, {Hae Young} and Cho, {Hyun Jai} and Lee, {Sang Eun} and Kim, {Min Seok} and Kim, {Jae Joong} and Hwang, {Kyung Kuk} and Chae, {Shung Chull} and Baek, {Sang Hong} and seokmin kang and Choi, {Dong Ju} and Byungsu Yoo and Kim, {Kye Hun} and Park, {Hyun Young} and Cho, {Myeong Chan} and Oh, {Byung Hee}",
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Choi, KH, Lee, GY, Choi, JO, Jeon, ES, Lee, HY, Cho, HJ, Lee, SE, Kim, MS, Kim, JJ, Hwang, KK, Chae, SC, Baek, SH, kang, S, Choi, DJ, Yoo, B, Kim, KH, Park, HY, Cho, MC & Oh, BH 2018, 'Effects of angiotensin receptor blocker at discharge in patients with heart failure with reduced ejection fraction: Korean Acute Heart Failure (KorAHF) registry', International Journal of Cardiology, vol. 257, pp. 168-176. https://doi.org/10.1016/j.ijcard.2017.12.002

Effects of angiotensin receptor blocker at discharge in patients with heart failure with reduced ejection fraction : Korean Acute Heart Failure (KorAHF) registry. / Choi, Ki Hong; Lee, Ga Yeon; Choi, Jin Oh; Jeon, Eun Seok; Lee, Hae Young; Cho, Hyun Jai; Lee, Sang Eun; Kim, Min Seok; Kim, Jae Joong; Hwang, Kyung Kuk; Chae, Shung Chull; Baek, Sang Hong; kang, seokmin; Choi, Dong Ju; Yoo, Byungsu; Kim, Kye Hun; Park, Hyun Young; Cho, Myeong Chan; Oh, Byung Hee.

In: International Journal of Cardiology, Vol. 257, 15.04.2018, p. 168-176.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effects of angiotensin receptor blocker at discharge in patients with heart failure with reduced ejection fraction

T2 - Korean Acute Heart Failure (KorAHF) registry

AU - Choi, Ki Hong

AU - Lee, Ga Yeon

AU - Choi, Jin Oh

AU - Jeon, Eun Seok

AU - Lee, Hae Young

AU - Cho, Hyun Jai

AU - Lee, Sang Eun

AU - Kim, Min Seok

AU - Kim, Jae Joong

AU - Hwang, Kyung Kuk

AU - Chae, Shung Chull

AU - Baek, Sang Hong

AU - kang, seokmin

AU - Choi, Dong Ju

AU - Yoo, Byungsu

AU - Kim, Kye Hun

AU - Park, Hyun Young

AU - Cho, Myeong Chan

AU - Oh, Byung Hee

PY - 2018/4/15

Y1 - 2018/4/15

N2 - Background: After introduction of up-titration strategy, there are limited data on comparison between the effects of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB) in patients with heart failure with reduced ejection fraction (HFrEF). The study sought to investigate the association between treatment with ARB at discharge and clinical outcomes in patients with HFrEF compared with treatment with ACEI or no renin angiotensin system blocker (RASB). Methods: The KorAHF registry is a prospective multicenter cohort and included patients who were hospitalized for acute heart failure (AHF). We studied 3005 patients with HFrEF (< 40%), and divided into ARB (n = 1190), ACEI (n = 1090), and no RASB (n = 725) groups. Propensity score matching was performed. Results: All-cause death occurred in 346 patients (29.1%) in the ARB group, 315 patients (28.9%) in the ACEI group, and 305 (42.1%) in the no RASB group. After propensity score matching (ARB vs. ACEI, 827 pairs), there was no significant difference between the two groups in the rate of death (HR 0.91, 95% CI 0.76–1.09, p = 0.32). All-cause death was significantly lower in the ARB group than in the no RASB group (ARB vs. no RASB, 538 pairs, HR 0.69, 95% CI 0.56–0.83, p < 0.001). The ARB group had a significantly lower discontinuation rate than the ACEI group (20.8% vs. 33.6%, p < 0.001). Conclusions: For treatment of AHF with reduced EF after hospitalization, ARB at discharge shows a mortality benefit comparable to that of ACEI. In addition, tolerability of medication was greater for ARB than for ACEI.

AB - Background: After introduction of up-titration strategy, there are limited data on comparison between the effects of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB) in patients with heart failure with reduced ejection fraction (HFrEF). The study sought to investigate the association between treatment with ARB at discharge and clinical outcomes in patients with HFrEF compared with treatment with ACEI or no renin angiotensin system blocker (RASB). Methods: The KorAHF registry is a prospective multicenter cohort and included patients who were hospitalized for acute heart failure (AHF). We studied 3005 patients with HFrEF (< 40%), and divided into ARB (n = 1190), ACEI (n = 1090), and no RASB (n = 725) groups. Propensity score matching was performed. Results: All-cause death occurred in 346 patients (29.1%) in the ARB group, 315 patients (28.9%) in the ACEI group, and 305 (42.1%) in the no RASB group. After propensity score matching (ARB vs. ACEI, 827 pairs), there was no significant difference between the two groups in the rate of death (HR 0.91, 95% CI 0.76–1.09, p = 0.32). All-cause death was significantly lower in the ARB group than in the no RASB group (ARB vs. no RASB, 538 pairs, HR 0.69, 95% CI 0.56–0.83, p < 0.001). The ARB group had a significantly lower discontinuation rate than the ACEI group (20.8% vs. 33.6%, p < 0.001). Conclusions: For treatment of AHF with reduced EF after hospitalization, ARB at discharge shows a mortality benefit comparable to that of ACEI. In addition, tolerability of medication was greater for ARB than for ACEI.

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