Renin-Angiotensin System Inhibition and Lower 30-day All-cause Readmission in Medicare Beneficiaries with Heart Failure

• Published in: The American journal of medicine Vol. 129; no. 10; pp. 1067 - 1073
• Main Authors: Sanam, Kumar, MD, Bhatia, Vikas, MD, Bajaj, Navkaranbir S., MD, Gaba, Saurabh, MD, Morgan, Charity J., PhD, Fonarow, Gregg C., MD, Butler, Javed, MD, Deedwania, Prakash, MD, Prabhu, Sumanth D., MD, Wu, Wen-Chih, MD, White, Michel, MD, Love, Thomas E., PhD, Aronow, Wilbert S., MD, Fletcher, Ross D., MD, Allman, Richard M., MD, Ahmed, Ali, MD MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016; Elsevier Sequoia S.A
• Subjects: ACEI or ARB; Aged; Aged, 80 and over; Alabama; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Cause of Death; Female; Heart failure; Heart Failure - drug therapy; Hospital readmission; Hospitalization; Humans; Internal Medicine; Male; Medical research; Medicare; Middle Aged; Mortality; Patient admissions; Patient Readmission - statistics & numerical data; Proportional Hazards Models; Protective Factors; Renin-Angiotensin System; Stroke Volume; United States; Ventricular Dysfunction, Left - drug therapy; heart failure; hospital readmission; ACEI or ARB; Heart failure; Hospital readmission
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2016.05.008

Background Heart failure is the leading cause for 30-day all-cause readmission, the reduction of which is a goal of the Affordable Care Act. There is a growing interest in understanding the impact of evidence-based heart failure therapy on 30-day all-cause readmission. In the current study, we examined the impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI-ARBs) on 30-day all-cause readmission in heart failure. Methods Of the 1384 hospitalized Medicare beneficiaries with heart failure and left ventricular ejection fraction <45% discharged alive from 106 Alabama hospitals (1998–2001) without prior ACEI-ARB use and without known contraindications to ACEI-ARB use, 734 received new pre-discharge prescriptions for these drugs. Using propensity scores for ACEI-ARB initiation, we assembled a matched cohort of 477 pairs of patients balanced on 32 baseline characteristics (mean age 75 years, 46% women, 26% African American). Results 30-day all-cause readmissions occurred in 18% and 24% of matched patients receiving and not receiving ACEI-ARBs, respectively (hazard ratio {HR}, 0.74; 95% confidence interval {CI}, 0.56–0.97; p=0.030). ACEI-ARB use was also associated with lower risk of 30-day all-cause mortality (HR, 0.56; 95% CI, 0.33–0.98; p=0.041) and of the combined endpoint of 30-day all-cause readmission or 30-day all-cause mortality (HR, 0.73; 95% CI, 0.56–0.94; p=0.017). All associations remained significant at 1-year post-discharge. Conclusions –Among hospitalized patients with heart failure and reduced ejection fraction, the use of ACEI-ARBs was associated with a significantly lower risk of 30-day all-cause readmission and 30-day all-cause mortality; both beneficial associations persisted during long-term follow-up.