Impact of chronic renin-angiotensin-aldosterone inhibitors on short-term outcomes in patients with acute heart failure presenting to the emergency department. A propensity-matched analysis EAHFE cohort

The aim of the present study was to evaluate the impact of chronic treatment with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) on short-term clinical outcomes after an episode of AHF. A secondary analysis of patients included in the EAHFE (Epidemiology of Ac...

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Published in:	International journal of cardiology Vol. 418; p. 132615
Main Authors:	Haro, Antoni, Rosselló, Xavier, Alquézar-Arbé, Aitor, Aguirre, Alfons, Piñera, Pascual, Gil, Víctor, Burillo-Putze, Guillermo, Cabello, Irene, Roset, Alex, Andueza, Juan Antonio, Tost, Josep, Garrido, Jose Manuel, Domingo, Eva, Calvo-Rodríguez, Rafael, Miró, Òscar, Fuentes, Marta, Davila, Aitor, del Amo, Sonia, Alonso, Héctor, Pérez-Llantada, Enrique, Martín-Sánchez, Francisco Javier, Escoda, Rosa, Sánchez, Carolina, Repullo, Daniel, Masso, Marta, Millán, Javier, Serrano, Leticia, Pavón, José, González, Nayra Cabrera, Rodríguez, Rafael Calvo, Reyes, Juan Antonio Vega, Juan, María Ángeles, Masó, Silvia Mínguez, Pérez, Virginia Fernández-Távora, Ramón, Susana Sánchez, Nicolás, José Andrés Sánchez, Aragüés, Paula Lázaro, Garate, Raquel Torres, Arias, Pilar Paz, Carrete, Carlos José Romero, Jacob, Javier, Haro, Antonio, Fuentes, Lidia, Richard, Fernando, Fernández, Elisa, Puente, Pablo Herrero, Álvarez, Joaquín Vázquez, García, Belén Prieto, Ramos, Belén Álvarez, Miranda, Natalia Fernández, Guzmán, Sergio, Jara, Gema, Felipe, Alba, Gil, Adriana, Romero, Rodolfo, López, Mariella Luengo, Domínguez, Gema, Ruíz, Martín, Arriaga, Beatriz Amores, Mojarro, Enrique Martín, Bécquer, Lisette Travería, Burillo, Guillermo, García, Lluís Llauger, de la Torre, María De Los Ángeles González, Jiménez, Carmen Esmeralda Romero, Ferrer, Ester Soy, Múñoz, María Adroher, Lucas-Imbernón, Francisco Javier, Gaya, Rut, Bibiano, Carlos, Mir, María, Rodríguez, Beatriz, Adrada, Esther Rodríguez, Baldrich, Eva Domingo, Carvajal, Marianela Guzmán, Fortuny, María José, García, Yelenis Gómez, Coronill, Verónica de las Nieves Segura, Esquivias, Marco Antonio, del Carmen Martínez Picón, María, Callejas, Marina Borox, García, Rocío Moyano, Rodríguez, Pablo, Cuevas, María Martínez, Noceda, José, Valladares, Jordi Estopá, González, Natalia Ramos, Lorenzo, Rocio, Valencia, Juan Bautista, Bembibre, Lorena, Guerrero, Inés Fernández, Garrido, José Manuel
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01-01-2025
Subjects:	Acute heart failure Angiotensin receptor blockers Angiotensin-converting enzyme inhibitors Emergency department Mortality Angiotensin-converting enzyme inhibitors Emergency department Mortality Acute heart failure Angiotensin receptor blockers
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Summary:	The aim of the present study was to evaluate the impact of chronic treatment with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) on short-term clinical outcomes after an episode of AHF. A secondary analysis of patients included in the EAHFE (Epidemiology of Acute Heart Failure in Emergency Departments) cohort, which includes patients diagnosed with AHF in 45 Spanish Emergency Departments (EDs). The primary outcome was all-cause in-hospital mortality. The secondary outcomes were all-cause death within 7 days, need for hospital admission and prolonged hospitalisation defined as a stay longer than or equal to 7 days. Multiple regression and propensity-matching was used for multivariate adjustment. Of the 17,920 patients, 10,041 (56 %) were receiving chronic treatment with ACEI/ARB. The mean age was 80.4 years and 55.7 % were women. Adjusted odds ratios (aOR) were 0.76 (95 % CI 0.71–0.82) for in-hospital mortality witch multiple regression and 0.74 (95 %CI 0.63–0.88) with propensity-matching. aOR were 0.72; (95 %CI 0.65–0.79) and 0.70 (95 %CI 0.57–0.87) for mortality at the 7-day follow-up, respectively. The sensitivity analysis ACEI/ARB were associated with few all-cause deaths in patients with elevated natriuretic peptides in the EDs (aOR 0.74; 95 % CI 0.68–0.80), patients requiring hospital admission (aOR 0.78; 95 % CI 0.73–0.84) and patients with a history of HF (aOR 0.72; 95 % CI 0.66–0.78). Chronic use of ACEI/ARB was associated with better short-term outcomes in terms of all-cause in-hospital mortality in patients with AHF who attend an EDs. [Display omitted] •Patients with heart failure are often given renin-angiotensin-aldosterone inhibitors.•Chronic use may improve clinical outcomes in patients with acute heart failure in the emergency department.•Renin-angiotensin-aldosterone inhibitors were associated with better short-term outcomes in acute heart failure.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0167-5273 1874-1754 1874-1754
DOI:	10.1016/j.ijcard.2024.132615