ACE Inhibitors More Protective Than Beta-Blockers in Heart Failure Survival

SAN FRANCISCO, CAPatients with heart failure with preserved ejection fraction (HFPEF) demonstrate improved survival when discharged on combination ACE inhibitors (ACEI) and beta-blockers or on ACEI therapy alone, as presented at ACC.13, the American College of Cardiology's 62nd Annual Scientific Session.

Data regarding the management of patients with HFPEF after an acute decompensation is scarce. Kevin Shah, MD, from Veterans Affairs San Diego Healthcare System, San Diego, CA, and his team of researchers assessed the survival benefit of ACEI and beta-blockers in patients with HFPEF and heart failure with reduced ejection fracture (HFREF).

This study was a secondary analysis of the BACH (Biomarkers in Acute Heart Failure) trial, which was a prospective, multi-center, international study of 1,641 patients presenting with dyspnea. HFPEF was defined as ejection fraction >50% and HPREF was defined as ejection fraction <50%. Patients included in the study were followed for 90 days after discharge, for all-cause mortality.

Results demonstrated that patients whom were discharged on both beta-blocker and ACEI therapy had an improved survival in both HFPEF (HR=0.071, P=0.001 and HR=0.207, P=0.03, respectively) and HFREF (HR=0.087, P<0.0001). Mortality was not improved in patients with HFPEF receiving beta-blockers alone (HR=0.285, P<0.079). The propensity score for being prescribed an ACEI was 0.708 (P<0.0001) and for beta-blocker was 0.622 (P<0.0001). The study model compared patients taking both beta-blocker and ACEI, ACEI alone, and beta-blocker alone.

In HPREF, beta-blocker use increased percent survival when compared to no beta-blocker use. Similarly, use of ACEI increased percent survival when compared to no ACEI use. In the HFPEF population, beta-blocker use improved percent survival (HR=0.272, P=0.022) when compared to no beta-blocker use.  ACEI improved percent survival (HR=0.205, P=0.006) when compared to no ACEI use.

Dr. Shah concluded that though both patient populations showed improved survival when discharged on ACEI and beta-blockers, the study model “should lead to further prospective heart failure studies.”