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Journal article
Patterns of Use and Clinical Outcomes with Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Acute Heart Failure and Changes in Kidney Function: An Analysis of the Veterans' Health Administrative Database
Cardiorenal medicine, v 11(5-6), pp 226-236
01 Dec 2021
PMID: 34601469
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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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Details
- Title
- Patterns of Use and Clinical Outcomes with Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Acute Heart Failure and Changes in Kidney Function: An Analysis of the Veterans' Health Administrative Database
- Creators
- Roy O. Mathew - Columbia VA Health Care SystemKevin Bryan Lo - Einstein Medical Center PhiladelphiaPadmavathi Tipparaju - Drexel Coll Med, Philadelphia, PA USAEvan Phelps - Columbia VA Health Care SystemMandeep S. Sidhu - Albany Medical Center HospitalSripal Bangalore - NYU, Dept Cardiol, Sch Med, New York, NY USACharles Herzog - Hennepin Healthcare Research InstituteMuthiah Vaduganathan - Harvard Med Sch, Brigham & Womens Hosp, Boston, MA 02115 USAW. H. Wilson Tang - Cleveland Clinic Lerner College of MedicineJanani Rangaswami - Einstein Medical Center Philadelphia
- Publication Details
- Cardiorenal medicine, v 11(5-6), pp 226-236
- Publisher
- Karger
- Number of pages
- 11
- Grant note
- University of South Carolina School of Medicine Research Center for Transforming Health Emerging Physician Scientist Program
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000704516900001
- Scopus ID
- 2-s2.0-85117219335
- Other Identifier
- 991021860761204721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Urology & Nephrology