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Initiation, Continuation, or Withdrawal of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction.

dc.contributor.author Bhatt, DL
dc.contributor.author Desai, AS
dc.contributor.author DeVore, Adam David
dc.contributor.author Fonarow, GC
dc.contributor.author Gilstrap, LG
dc.contributor.author Heidenreich, Paul A
dc.contributor.author Hernandez, Adrian Felipe
dc.contributor.author Liang, L
dc.contributor.author Matsouaka, Roland Albert
dc.contributor.author Smith, EE
dc.contributor.author Yancy, Clyde W
dc.coverage.spatial England
dc.date.accessioned 2017-11-01T16:31:52Z
dc.date.available 2017-11-01T16:31:52Z
dc.date.issued 2017-02-11
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/28189999
dc.identifier JAHA.116.004675
dc.identifier.uri http://hdl.handle.net/10161/15725
dc.description.abstract BACKGROUND: Guidelines recommend continuation or initiation of guideline-directed medical therapy, including angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARB), in hospitalized patients with heart failure with reduced ejection fraction. METHODS AND RESULTS: Using the Get With The Guidelines-Heart Failure Registry, we linked clinical data from 16 052 heart failure with reduced ejection fraction (ejection fraction ≤40%) patients with Medicare claims data. We divided ACEi/ARB-eligible patients into 4 categories based on admission and discharge ACEi/ARB use: continued (reference group), started, discontinued, or not started on therapy. A multivariable Cox proportional hazard model was used to determine the association between ACEi/ARB category and outcomes. Most, 90.5%, were discharged on ACEi/ARB (59.6% continued and 30.9% newly started). Of those discharged without ACEi/ARB, 1.9% were discontinued, and 7.5% were eligible but not started. Thirty-day mortality was 3.5% for patients continued and 4.1% for patients started on ACEi/ARB. In contrast, 30-day mortality was 8.8% for patients discontinued (adjusted hazard ratio [HRadj] 1.92; 95% CI 1.32-2.81; P<0.001) and 7.5% for patients not started (HRadj 1.50; 95% CI 1.12-2.00; P=0.006). The 30-day readmission rate was lowest among patients continued or started on therapy. One-year mortality was 28.2% for patients continued and 29.7% for patients started on ACEi/ARB compared to 41.6% for patients discontinued (HRadj 1.35; 95% CI 1.13-1.61; P<0.001) and 41.7% (HRadj 1.28; 95% CI 1.14-1.43; P<0.001) for patients not started on therapy. CONCLUSIONS: Compared with continuation, withdrawal of ACEi/ARB during heart failure hospitalization is associated with higher rates of postdischarge mortality and readmission, even after adjustment for severity of illness.
dc.language eng
dc.relation.ispartof J Am Heart Assoc
dc.relation.isversionof 10.1161/JAHA.116.004675
dc.subject angiotensin II receptor blockers
dc.subject angiotensin‐converting enzyme inhibitors
dc.subject heart failure
dc.subject outcomes research
dc.subject quality of care
dc.title Initiation, Continuation, or Withdrawal of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/28189999
pubs.issue 2
pubs.organisational-group Basic Science Departments
pubs.organisational-group Biostatistics & Bioinformatics
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group School of Medicine
pubs.publication-status Published online
pubs.volume 6
dc.identifier.eissn 2047-9980


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