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. 2021 Jun;8(3):1944-1953.
doi: 10.1002/ehf2.13223. Epub 2021 Mar 4.

Adherence and optimization of angiotensin converting enzyme inhibitor/angiotensin II receptors blockers and beta-blockers in patients hospitalized for acute heart failure

Valentina Carubelli  1   2 , Carlo Lombardi  1   2 , Claudia Specchia  3 , Giulia Peveri  4 , Chiara Oriecuia  3 , Daniela Tomasoni  1   2 , Mattia Di Pasquale  1   2 , Riccardo Inciardi  1   2 , Emirena Garrafa  3   5 , Marco Metra  1   2
Affiliations

Adherence and optimization of angiotensin converting enzyme inhibitor/angiotensin II receptors blockers and beta-blockers in patients hospitalized for acute heart failure

Valentina Carubelli et al. ESC Heart Fail. 2021 Jun.

Abstract

Aims: Treatment with angiotensin converting enzyme inhibitor (ACEi)/angiotensin II receptors blockers (ARBs) and beta-blockers is frequently suboptimal at discharge in patients hospitalized for acute heart failure (AHF). We investigated the prognostic significance of medical treatment at discharge and its changes during hospitalization.

Methods and results: In a retrospective analysis, we included 623 patients hospitalized for AHF with reduced left ventricular ejection fraction (<40%). The primary endpoint was all-cause mortality and heart failure rehospitalization to Day 180 since hospital discharge. A total of 249 (42.4%) of patients received no ACEi/ARBs/BB or <50% target dose (TD) of these drugs, 249 (42.4%) had either ACEi/ARBs or BB ≥ 50% of TD, and 89 (15.2%) ACEi/ARBs and BB ≥ 50% of TD at discharge. The primary endpoint was significantly lower in patients receiving at least one drug ≥50% of TD compared with no or low-dose treatment (ACEi/ARBs or BB ≥ 50% TD: adjusted hazard ratio (HR) 0.69, 95% confidence interval (CI) [0.49-0.98], P = 0.04; ACEi/ARBs and BB ≥ 50% TD: adjusted HR 0.54, 95% CI [0.30-0.96], P = 0.03). With regard to treatment changes from admission to discharge, therapy was decreased in 258 (44.6%) patients, stable in 194 (33.6%), and increased in 126 (21.8%). Compared with patients with stable therapy, treatment intensification was associated with a lower rate of the primary endpoint (adjusted HR 0.49, 95% CI [0.29-0.83]; P = 0.01).

Conclusions: In patients with AHF, prescription of ACEi/ARBs/BB ≥ 50% TD at the time of discharge, whether achieved or not through treatment intensification during the hospitalization, is associated with better post-discharge outcomes.

Keywords: ACE-inhibitors; Acute heart failure; Beta-blockers; Outcomes; Therapy.

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Conflict of interest statement

V. C. received consulting honoraria from CVie Therapeutics Limited, Servier, and Windtree Therapeutics. M. M. reports personal consulting honoraria from Bayer, Novartis, Fresenius, Servier, and Windtree Therapeutics for participation to advisory board meetings and executive committees of clinical trials. All the other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Flow diagram of the study population.
Figure 2
Figure 2
Kaplan–Meier plot for the combined endpoints of death or HF hospitalizations to Day 180, according to therapy at discharge (N = 587 with non‐missing information). ACEi, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptors blocker; BB, beta‐blockers; TD, target dose.
Figure 3
Figure 3
Kaplan–Meier plot for the combined endpoints of death or heart failure hospitalizations to Day 180, according the variation of therapy from admission to discharge (N = 578 with non‐missing information).
See this image and copyright information in PMC

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