Outcomes of ARBs, ACE Inhibitors Use in HF Patients With Renal Impairment

Association between eGFR, ACEi/ARB use, and mortality studied
Association between eGFR, ACEi/ARB use, and mortality studied

WASHINGTON, DC—According to data presented at the ACC.17 Scientific Session, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) were associated with decreased mortality in heart failure (HF) patients regardless of kidney function.

Michael Chiu, and colleagues from the University of Calgary, Calgary, Canada, performed a cohort study (n=1,404) to describe the association between estimated glomerular filtration rate (eGFR), ACE inhibitor or ARB use, and survival among patient discharged after HF hospitalization between 2008–2012. "Adjusted survival models were used to evaluate the association between ACE inhibitor or ARB use and all-cause mortality, and to determine whether kidney function was a modifier of this association," Chiu explained.

Patients with a reduced eGFR exhibited significantly lower rates of ACE inhibitor or ARB use in the first 3 months following hospital discharge vs. patients with normal kidney function. Specifically, 71% of patients with eGFR >90mL/min/1.73m2, 67% of patients with eGFR 45–89mL/min/1.73m2, 62% of patients with eGFR 30-44mL/min/1.73m2, and 52% of patients with eGFR <30mL/min/1.73m2 had ACE inhibitor or ARB use. Adjusted Cox regression models showed a 25% reduced hazard of death with ACE inhibitor or ARB use after discharge (hazard ratio [HR] 0.75, 95% CI: 0.61–0.92; P=0.006), without evidence that this relationship varied by eGFR. 

Across all eGFR categories, researchers observed an increased use of beta-blockers. Patients with eGFR <30mL/min/1.73m2 showed the highest rates of pre-admission prescription. In contrast, "prescription rates were significantly lower at all time points among those with eGFR <30mL/min/1.73m2 (P<0.001)" for aldosterone antagonists, Chiu added.

In general, patients with reduced eGFR were less likely to receive ACE inhibitor/ARB after hospitalization for HF but "we found no evidence that the association between ACE inhibitor/ARB use and survival differed according to discharge eGFR," Chiu concluded. "Further research is needed on the effects of continuing vs. withdrawing ACE inhibitor or ARB in patients with acutely decompensated HF and kidney dysfunction."