Gregory Berra1, Nicolas Garin2, Jérôme Stirnemann3, Anne-Sophie Jannot4, Pierre-Yves Martin5, Arnaud Perrier3, Sebastian Carballo3. 1. Division of Internal Medicine, Internal Medecine and Rehabilitation Department, Geneva University Hospitals, Geneva, Switzerland. Electronic address: gregory.berra@hcuge.ch. 2. Division of Internal Medicine, Medecine Department, Chablais Regional Hospital, Monthey, Switzerland. 3. Division of Internal Medicine, Internal Medecine and Rehabilitation Department, Geneva University Hospitals, Geneva, Switzerland. 4. Division of Epidemiology, Quality and Medical Direction Department, Geneva University Hospitals, Geneva, Switzerland. 5. Division of Nephrology, Medical Specialties Department, Geneva University Hospitals, Geneva, Switzerland.
Abstract
BACKGROUND: The prognostic value of worsening renal function (WRF) in acute heart failure is debated. Moreover, it is not clear if the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in this context is detrimental. METHOD AND RESULTS: In a retrospective cohort study of 646 patients hospitalized for acute heart failure, the risk of death or readmission associated with acute kidney injury (AKI) present at admission, WRF during the 1st 7 days, and up-titration of ACEI/ARB were analyzed in a Cox proportional hazards model. AKI, WRF, hemoglobin concentration, ACEI/ARB up-titration, and use of loop diuretics before admission were significantly associated with the primary outcome in univariate analysis. In a multivariate model, the association remained significant for AKI (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.13-1.47; P = .0002), WRF (HR 1.24, 95% CI 1.06-1.45; P = .0059), and ACEI/ARB up-titration (HR 0.79, 95% CI 0.64-0.97; P = .026). There was no excess mortality in patients with ACEI/ARB up-titration despite WRF. CONCLUSIONS: Both AKI and WRF are strongly associated with poor outcome in patients hospitalized for acute heart failure. ACEI/ARB up-titration seems to be protective.
BACKGROUND: The prognostic value of worsening renal function (WRF) in acute heart failure is debated. Moreover, it is not clear if the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in this context is detrimental. METHOD AND RESULTS: In a retrospective cohort study of 646 patients hospitalized for acute heart failure, the risk of death or readmission associated with acute kidney injury (AKI) present at admission, WRF during the 1st 7 days, and up-titration of ACEI/ARB were analyzed in a Cox proportional hazards model. AKI, WRF, hemoglobin concentration, ACEI/ARB up-titration, and use of loop diuretics before admission were significantly associated with the primary outcome in univariate analysis. In a multivariate model, the association remained significant for AKI (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.13-1.47; P = .0002), WRF (HR 1.24, 95% CI 1.06-1.45; P = .0059), and ACEI/ARB up-titration (HR 0.79, 95% CI 0.64-0.97; P = .026). There was no excess mortality in patients with ACEI/ARB up-titration despite WRF. CONCLUSIONS: Both AKI and WRF are strongly associated with poor outcome in patients hospitalized for acute heart failure. ACEI/ARB up-titration seems to be protective.
Authors: David Carballo; Jérôme Stirnemann; Nicolas Garin; Chistophe Marti; Jacques Serratrice; Sebastian Carballo Journal: ESC Heart Fail Date: 2020-03-13
Authors: Sebastian Carballo; Philippe Musso; Nicolas Garin; Hajo Müller; Jacques Serratrice; François Mach; David Carballo; Jérôme Stirnemann Journal: J Clin Med Date: 2019-10-15 Impact factor: 4.241