Association between prognosis and the use of angiotensin‐converting enzyme inhibitors and/or angiotensin II receptor blockers in frail patients with heart failure with preserved ejection fraction
Abstract Aims The effectiveness of angiotensin‐converting enzyme inhibitors (ACE‐I) and angiotensin II receptor blockers (ARB) has not been demonstrated in patients with heart failure with preserved ejection fraction (HFpEF). We recently reported significant interaction between the use of ACE‐I and/...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-06-01
|
| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13873 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832540361976709120 |
|---|---|
| author | Akihiro Sunaga Shungo Hikoso Shunsuke Tamaki Masahiro Seo Masamichi Yano Takaharu Hayashi Akito Nakagawa Yusuke Nakagawa Hiroyuki Kurakami Tomomi Yamada Tetsuhisa Kitamura Taiki Sato Bolrathanak Oeun Hirota Kida Yohei Sotomi Tomoharu Dohi Katsuki Okada Hiroya Mizuno Daisaku Nakatani Takahisa Yamada Yoshio Yasumura Yasushi Sakata OCVC‐Heart Failure Investigators |
| author_facet | Akihiro Sunaga Shungo Hikoso Shunsuke Tamaki Masahiro Seo Masamichi Yano Takaharu Hayashi Akito Nakagawa Yusuke Nakagawa Hiroyuki Kurakami Tomomi Yamada Tetsuhisa Kitamura Taiki Sato Bolrathanak Oeun Hirota Kida Yohei Sotomi Tomoharu Dohi Katsuki Okada Hiroya Mizuno Daisaku Nakatani Takahisa Yamada Yoshio Yasumura Yasushi Sakata OCVC‐Heart Failure Investigators |
| author_sort | Akihiro Sunaga |
| collection | DOAJ |
| description | Abstract Aims The effectiveness of angiotensin‐converting enzyme inhibitors (ACE‐I) and angiotensin II receptor blockers (ARB) has not been demonstrated in patients with heart failure with preserved ejection fraction (HFpEF). We recently reported significant interaction between the use of ACE‐I and/or ARB (ACE‐I/ARB) and frailty on prognosis in patients with HFpEF. In the present study, we examined the association between ACE‐I/ARB and prognosis in patients with HFpEF stratified by the presence or absence of frailty. Methods and results We examined the association between the use of ACE‐I/ARB and prognosis according to the presence [Clinical Frailty Scale (CFS) ≥ 5] or absence (CFS ≤ 4) of frailty in patients with HFpEF in a post hoc analysis of registry data. Primary endpoint was the composite of all‐cause mortality and heart failure admission. Secondary endpoints were all‐cause mortality and heart failure admission. Of 1059 patients, median age was 83 years and 45% were male. Kaplan–Meier analysis showed that the risk of composite endpoint (log‐rank P = 0.001) and all‐cause death (log‐rank P = 0.005) in patients with ACE‐I/ARB was lower in those with CFS ≥ 5, but similar between patients with and without ACE‐I/ARB in patients with CFS ≤ 4 (composite endpoint: log‐rank P = 0.830; all‐cause death: log‐rank P = 0.192). In a multivariable Cox proportional hazards model, use of ACE‐I/ARB was significantly associated with lower risk of the composite endpoint [hazard ratio (HR) = 0.52, 95% confidence interval (CI) = 0.33–0.83, P = 0.005] and heart failure admission (HR = 0.45, 95% CI = 0.25–0.83, P = 0.010) in patients with CFS ≥ 5, but not in patients with CFS ≤ 4 (composite endpoint: HR = 1.41, 95% CI = 0.99–2.02, P = 0.059; heart failure admission: HR = 1.43, 95% CI = 0.94–2.18, P = 0.091). The association between ACE‐I or ARB and prognosis did not significantly differ by CFS (CFS ≤ 4: log‐rank P = 0.562; CFS ≥ 5: log‐rank P = 0.100, for with ACE‐I vs. ARB, respectively). Adjusted HRs for CFS 1–4 were higher than 1.0 but were <1.0 at CFS 5. Conclusions In patients with HFpEF, use of ACE‐I/ARB was associated with better prognosis in patients with frailty as assessed with the CFS, but not in those without frailty. |
| format | Article |
| id | doaj-art-f5044c05ebb84b12b99cd859efb62149 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-f5044c05ebb84b12b99cd859efb621492025-02-05T05:22:10ZengWileyESC Heart Failure2055-58222022-06-01931801181110.1002/ehf2.13873Association between prognosis and the use of angiotensin‐converting enzyme inhibitors and/or angiotensin II receptor blockers in frail patients with heart failure with preserved ejection fractionAkihiro Sunaga0Shungo Hikoso1Shunsuke Tamaki2Masahiro Seo3Masamichi Yano4Takaharu Hayashi5Akito Nakagawa6Yusuke Nakagawa7Hiroyuki Kurakami8Tomomi Yamada9Tetsuhisa Kitamura10Taiki Sato11Bolrathanak Oeun12Hirota Kida13Yohei Sotomi14Tomoharu Dohi15Katsuki Okada16Hiroya Mizuno17Daisaku Nakatani18Takahisa Yamada19Yoshio Yasumura20Yasushi Sakata21OCVC‐Heart Failure InvestigatorsDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanDepartment of Cardiology Rinku General Medical Center Osaka JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Osaka Rosai Hospital Sakai JapanCardiovascular Division Osaka Police Hospital Osaka JapanDivision of Cardiology Amagasaki Chuo Hospital Amagasaki JapanDivision of Cardiology Kawanishi City Hospital Kawanishi JapanDepartment of Medical Innovation Osaka University Hospital Suita JapanDepartment of Medical Innovation Osaka University Hospital Suita JapanDepartment of Social and Environmental Medicine Osaka University Graduate School of Medicine Suita JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanDivision of Cardiology Osaka General Medical Center Osaka JapanDivision of Cardiology Amagasaki Chuo Hospital Amagasaki JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanAbstract Aims The effectiveness of angiotensin‐converting enzyme inhibitors (ACE‐I) and angiotensin II receptor blockers (ARB) has not been demonstrated in patients with heart failure with preserved ejection fraction (HFpEF). We recently reported significant interaction between the use of ACE‐I and/or ARB (ACE‐I/ARB) and frailty on prognosis in patients with HFpEF. In the present study, we examined the association between ACE‐I/ARB and prognosis in patients with HFpEF stratified by the presence or absence of frailty. Methods and results We examined the association between the use of ACE‐I/ARB and prognosis according to the presence [Clinical Frailty Scale (CFS) ≥ 5] or absence (CFS ≤ 4) of frailty in patients with HFpEF in a post hoc analysis of registry data. Primary endpoint was the composite of all‐cause mortality and heart failure admission. Secondary endpoints were all‐cause mortality and heart failure admission. Of 1059 patients, median age was 83 years and 45% were male. Kaplan–Meier analysis showed that the risk of composite endpoint (log‐rank P = 0.001) and all‐cause death (log‐rank P = 0.005) in patients with ACE‐I/ARB was lower in those with CFS ≥ 5, but similar between patients with and without ACE‐I/ARB in patients with CFS ≤ 4 (composite endpoint: log‐rank P = 0.830; all‐cause death: log‐rank P = 0.192). In a multivariable Cox proportional hazards model, use of ACE‐I/ARB was significantly associated with lower risk of the composite endpoint [hazard ratio (HR) = 0.52, 95% confidence interval (CI) = 0.33–0.83, P = 0.005] and heart failure admission (HR = 0.45, 95% CI = 0.25–0.83, P = 0.010) in patients with CFS ≥ 5, but not in patients with CFS ≤ 4 (composite endpoint: HR = 1.41, 95% CI = 0.99–2.02, P = 0.059; heart failure admission: HR = 1.43, 95% CI = 0.94–2.18, P = 0.091). The association between ACE‐I or ARB and prognosis did not significantly differ by CFS (CFS ≤ 4: log‐rank P = 0.562; CFS ≥ 5: log‐rank P = 0.100, for with ACE‐I vs. ARB, respectively). Adjusted HRs for CFS 1–4 were higher than 1.0 but were <1.0 at CFS 5. Conclusions In patients with HFpEF, use of ACE‐I/ARB was associated with better prognosis in patients with frailty as assessed with the CFS, but not in those without frailty.https://doi.org/10.1002/ehf2.13873Heart failure with preserved ejection fractionClinical Frailty ScaleACE‐IARB |
| spellingShingle | Akihiro Sunaga Shungo Hikoso Shunsuke Tamaki Masahiro Seo Masamichi Yano Takaharu Hayashi Akito Nakagawa Yusuke Nakagawa Hiroyuki Kurakami Tomomi Yamada Tetsuhisa Kitamura Taiki Sato Bolrathanak Oeun Hirota Kida Yohei Sotomi Tomoharu Dohi Katsuki Okada Hiroya Mizuno Daisaku Nakatani Takahisa Yamada Yoshio Yasumura Yasushi Sakata OCVC‐Heart Failure Investigators Association between prognosis and the use of angiotensin‐converting enzyme inhibitors and/or angiotensin II receptor blockers in frail patients with heart failure with preserved ejection fraction ESC Heart Failure Heart failure with preserved ejection fraction Clinical Frailty Scale ACE‐I ARB |
| title | Association between prognosis and the use of angiotensin‐converting enzyme inhibitors and/or angiotensin II receptor blockers in frail patients with heart failure with preserved ejection fraction |
| title_full | Association between prognosis and the use of angiotensin‐converting enzyme inhibitors and/or angiotensin II receptor blockers in frail patients with heart failure with preserved ejection fraction |
| title_fullStr | Association between prognosis and the use of angiotensin‐converting enzyme inhibitors and/or angiotensin II receptor blockers in frail patients with heart failure with preserved ejection fraction |
| title_full_unstemmed | Association between prognosis and the use of angiotensin‐converting enzyme inhibitors and/or angiotensin II receptor blockers in frail patients with heart failure with preserved ejection fraction |
| title_short | Association between prognosis and the use of angiotensin‐converting enzyme inhibitors and/or angiotensin II receptor blockers in frail patients with heart failure with preserved ejection fraction |
| title_sort | association between prognosis and the use of angiotensin converting enzyme inhibitors and or angiotensin ii receptor blockers in frail patients with heart failure with preserved ejection fraction |
| topic | Heart failure with preserved ejection fraction Clinical Frailty Scale ACE‐I ARB |
| url | https://doi.org/10.1002/ehf2.13873 |
| work_keys_str_mv | AT akihirosunaga associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT shungohikoso associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT shunsuketamaki associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT masahiroseo associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT masamichiyano associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT takaharuhayashi associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT akitonakagawa associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT yusukenakagawa associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT hiroyukikurakami associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT tomomiyamada associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT tetsuhisakitamura associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT taikisato associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT bolrathanakoeun associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT hirotakida associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT yoheisotomi associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT tomoharudohi associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT katsukiokada associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT hiroyamizuno associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT daisakunakatani associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT takahisayamada associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT yoshioyasumura associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT yasushisakata associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction AT ocvcheartfailureinvestigators associationbetweenprognosisandtheuseofangiotensinconvertingenzymeinhibitorsandorangiotensiniireceptorblockersinfrailpatientswithheartfailurewithpreservedejectionfraction |