Abstract 12031: Initiation, Continuation, or Withdrawal of Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

Abstract

Background: Guidelines recommend continuation or initiation of treatment with angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARB) in hospitalized patients with heart failure with reduced ejection fraction (HFrEF). Methods: Using data from Get With The Guidelines-Heart Failure, we linked 16,052 HFrEF patients with Medicare claims. We divided patients into 4 categories based on admission and discharge ACEi/ARB use: continued, started, discontinued, or not started. A multivariable Cox proportional hazard model was performed to determine the association between the categories and 30-day, 90-day and 1-year outcomes. Results: A total of 90.6% of patients were discharged on ACEi/ARB (59.6% continued, 30.9% started, 1.9% discontinued, 7.5% not started). The 30-day mortality rate was higher, 8.8% for those discontinued (HR adj 2.04; 95% CI 1.42, 2.92; P<0.001) and 7.5% for those not started (HR adj 1.55; 95% CI 1.16, 2.07, P=0.003), compared with 3.5% for those continued on ACEi/ARB. There was no significant difference in 30-day mortality between those continued and those started. The 30-day readmission rate was higher, 28.6% for those discontinued (HR adj 1.44; 95% CI 1.19, 1.75; P<0.001) and 23.3% for those not started (HR adj 1.17, 95% CI 1.03, 1.32, P=0.013), compared with 18.3% for those continued on ACEi/ARB. Again, there was no significant difference in 30-day readmissions between those continued and those started. By one year, the mortality rate was lowest among those continued on ACEi/ARB compared to those discontinued (HR adj 1.42; 95% CI 1.18, 1.70, P<0.001) or not started (HR adj 1.32, 95% CI 1.18, 1.47, P<0.001). Conclusions: Initiation or continuation of ACEi/ARB therapy after an admission with HFrEF is associated with lower 30-day mortality and readmission rates. The lower mortality associated with continuing ACEi/ARB therapy persists out to 1 year.