Kenji Yoshioka1,2, Yuya Matsue3,4, Tetsuo Yamaguchi5, Takeshi Kitai6, Nobuyuki Kagiyama7, Takahiro Okumura8, Keisuke Kida9, Shogo Oishi10, Eiichi Akiyama11, Satoshi Suzuki12, Masayoshi Yamamoto13, Shunsuke Kuroda1,2, Akihiko Matsumura1, Kenzo Hirao2. 1. Department of Cardiology, Kameda Medical Center, Chiba, Japan. 2. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 3. Department of Cardiovascular Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan. yuya8950@gmail.com. 4. Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. yuya8950@gmail.com. 5. Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan. 6. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. 7. Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 8. Department of Cardiology, Nagoya University School of Medicine, Nagoya, Japan. 9. Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan. 10. Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan. 11. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. 12. Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan. 13. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Abstract
BACKGROUND: Although angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been recommended for patients with heart failure, their clinical and prognostic impact in the very acute phase of acute heart failure (AHF) is unclear, mainly because data on their safety and efficacy are lacking. METHODS: This study was a post hoc analysis of the REALITY-AHF trial. Patients with AHF who did not take an ACEI or ARB at admission were enrolled. Patients who received these medications within 48 h of admission were categorized as the ACEI/ARB group, and all other patients were categorized as the no ACEI/ARB group. The primary endpoint was a composite of all-cause death and heart failure readmission within 1 year of admission. RESULTS: Of the 1682 patients in the REALITY-AHF cohort, 900 were enrolled in this study, and 288 (32%) were included in the ACEI/ARB group. After propensity score matching, 152 pairs were evaluated, and no significant difference was found for in-hospital mortality, worsening renal function, or length of hospital stay. The ACEI/ARB group had significantly higher event-free survival (hazard ratio 0.51; 95% confidence interval 0.32-0.82; p = 0.006). CONCLUSIONS: Early initiation of ACEIs/ARBs within 48 h of admission for hospitalized patients with AHF was not associated with adverse events and correlated with improved outcomes at 1 year from admission.
RCT Entities:
BACKGROUND: Although angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been recommended for patients with heart failure, their clinical and prognostic impact in the very acute phase of acute heart failure (AHF) is unclear, mainly because data on their safety and efficacy are lacking. METHODS: This study was a post hoc analysis of the REALITY-AHF trial. Patients with AHF who did not take an ACEI or ARB at admission were enrolled. Patients who received these medications within 48 h of admission were categorized as the ACEI/ARB group, and all other patients were categorized as the no ACEI/ARB group. The primary endpoint was a composite of all-cause death and heart failure readmission within 1 year of admission. RESULTS: Of the 1682 patients in the REALITY-AHF cohort, 900 were enrolled in this study, and 288 (32%) were included in the ACEI/ARB group. After propensity score matching, 152 pairs were evaluated, and no significant difference was found for in-hospital mortality, worsening renal function, or length of hospital stay. The ACEI/ARB group had significantly higher event-free survival (hazard ratio 0.51; 95% confidence interval 0.32-0.82; p = 0.006). CONCLUSIONS: Early initiation of ACEIs/ARBs within 48 h of admission for hospitalized patients with AHF was not associated with adverse events and correlated with improved outcomes at 1 year from admission.