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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.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

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 SM,Choi DJ,Yoo BS,Kim KH,Park HY,Cho MC,Oh BH

doi

10.1016/j.ijcard.2017.12.002

subject

Has Abstract

pub_date

2018-04-15 00:00:00

pages

168-176

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(17)33640-9

journal_volume

257

pub_type

杂志文章,多中心研究

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Effects of angiotensin receptor blocker at discharge in patients with heart failure with reduced ejection fraction: Korean Acute Heart Failure (KorAHF) registry.