A Propensity-Matched Study of the Comparative Effectiveness of Angiotensin Receptor Blockers Versus Angiotensin-Converting Enzyme Inhibitors in Heart Failure Patients Age ≥65 Years
| Autor: | Richard M. Allman, Raynald Levesque, Firoozeh Farahmand, Thomas E. Love, Gregg C. Fonarow, Yan Zhang, Inmaculada Aban, Meredith L. Kilgore, Ali Ahmed, Paul W. Sanders |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Matched-Pair Analysis Angiotensin-Converting Enzyme Inhibitors Article Angiotensin Receptor Antagonists Internal medicine medicine Humans Registries cardiovascular diseases Propensity Score Aged Heart Failure Ejection fraction biology business.industry Hazard ratio Stroke Volume Angiotensin-converting enzyme medicine.disease Confidence interval Hospitalization Heart failure Multivariate Analysis ACE inhibitor Cohort biology.protein Cardiology Female Cardiology and Cardiovascular Medicine business Follow-Up Studies medicine.drug |
| Zdroj: | The American Journal of Cardiology. 108:1443-1448 |
| ISSN: | 0002-9149 |
| DOI: | 10.1016/j.amjcard.2011.06.066 |
| Popis: | The comparative effectiveness of angiotensin-converting enzyme (ACE) inhibitors versus angiotensin II type 1 receptor blockers (ARBs) in real-world older heart failure (HF) patients remains unclear. Of the 8,049 hospitalized HF patients aged ≥ 65 years discharged alive from 106 Alabama hospitals, 4,044 received discharge prescriptions of either ACE inhibitors (n = 3,383) or ARBs (n = 661). Propensity scores for ARB use, calculated for each of 4,044 patients, were used to match 655 (99% of 661) patients receiving ARBs with 661 patients receiving ACE inhibitors. The assembled cohort of 655 pairs of patients was well balanced on 56 baseline characteristics. During8 years of follow-up, all-cause mortality occurred in 63% and 68% of matched patients receiving ARBs and ACE inhibitors, respectively (hazard ratio [HR] associated with ARB use 0.86, 95% confidence interval [CI] 0.75 to 0.99, p = 0.031). Among the 956 matched patients with data on the left ventricular ejection fraction (LVEF), the association between ARB (vs ACE inhibitor) use was significant in only 419 patients with LVEFs ≥ 45% (HR 0.65, 95% CI 0.51 to 0.84, p = 0.001) but not in the 537 patients with LVEFs45% (HR 1.00, 95% CI 0.81 to 1.23, p = 0.999; p for interaction = 0.012). HRs for HF hospitalization associated with ARB use were 0.99 (95% CI 0.86 to 1.14, p = 0.876) overall, 0.80 (95% CI 0.63 to 1.03, p = 0.080) in those with LVEFs ≥45%, and 1.14 (95% CI 0.91 to 1.43, p = 0.246) in those with LVEFs45% (p for interaction = 0.060). In conclusion, in older HF patients with preserved LVEFs, discharge prescriptions of ARBs (vs ACE inhibitors) were associated with lower mortality and a trend toward lower HF hospitalization, findings that need replication in other HF populations. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect