Impact of left ventricular ejection fraction on the effect of renin-angiotensin system blockers after an episode of acute heart failure: From the KCHF Registry

• Published in: PloS one Vol. 15; no. 9; p. e0239100
• Main Authors: Yoshikawa, Yusuke, Tamaki, Yodo, Morimoto, Takeshi, Yaku, Hidenori, Yamamoto, Erika, Inuzuka, Yasutaka, Ozasa, Neiko, Kitai, Takeshi, Nagao, Kazuya, Sato, Yukihito, Kondo, Hirokazu, Tamura, Toshihiro, Nakagawa, Yoshihisa, Kuwahara, Koichiro, Kato, Takao, Kimura, Takeshi
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 14.09.2020; Public Library of Science (PLoS)
• Subjects: Angiotensin; Angiotensin converting enzyme inhibitors; Angiotensin II receptor blockers; Attorneys general; Biology and Life Sciences; Cardiac output; Cardiology; Clinical outcomes; Congestive heart failure; Drug therapy; Ejection fraction; Enzyme inhibitors; Epidemiology; Health aspects; Health risks; Heart failure; Hospitalization; Medicine; Medicine and Health Sciences; Patient outcomes; Patients; Peptidyl-dipeptidase A; Physicians; Prognosis; Renin; Statistical analysis; Stroke; Supervision; University graduates; Ventricle; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0239100

This observational study aimed to examine the prognostic association of angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARB) in different left ventricular ejection fraction (LVEF) categories. In 3717 patients enrolled in the KCHF Registry, a multicentre registry including consecutive patients hospitalized for acute heart failure (HF), we assessed patient characteristics and association between ACE-I/ARB and clinical outcomes according to LVEF. In the three LVEF categories (reduced LVEF [HFrEF], mid-range LVEF [HFmrEF] and preserved LVEF [HFpEF]), we compared the patients with ACE-I/ARB as discharge medication and those without, and assessed their 1-year clinical outcomes. We defined the primary outcome measure as a composite of all-cause death and HF hospitalization. The 1-year cumulative incidences of the primary outcome measure were 36.3% in HFrEF, 30.1% in HFmrEF and 33.8% in HFpEF (log-rank P = 0.07). The adjusted risks of the ACE-I/ARB group relative to the no ACE-I/ARB group for the primary outcome measure were significantly lower in HFrEF and HFmrEF (HR 0.66 [95%CI 0.54-0.79], P<0.001, and HR 0.61 [0.45-0.82], P = 0.001, respectively), but not in HFpEF (HR 0.95 [0.80-1.14], P = 0.61). There was a significant interaction between the LVEF category and the ACE-I/ARB use on the primary outcome measure (P.sub.interaction = 0.01). ACE-I/ARB for patients who were hospitalized for acute HF was associated with significantly lower risk for a composite of all-cause death and HF hospitalization in HFrEF and HFmrEF, but not in HFpEF. ACE-I/ARB might be a potential treatment option in HFmrEF as in HFrEF.