Abstract 19094: Use of ACE Inhibitors or Angiotensin Receptor Blockers is Associated With a Significantly Lower Risk of 30-day All-cause and Heart Failure Readmissions and All-cause Mortality in Older Medicare Beneficiaries Hospitalized for Heart Failure Developing Acute Kidney Injury

Abstract

Background: We presented data that demonstrating that acute kidney injury (AKI) as defined by a rise in admission serum creatinine by ≥0.3mg/dL is associated with a 16% significant increase in 30-day all-cause readmission in hospitalized heart failure (HF) patients (Circulation. 2014; 130: A19999). We have previously published data suggesting that the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) is associated with improved outcomes in HF patients with chronic kidney disease (PMC3324926 and PMC3575519). However, these drugs are often avoided in HF patients with AKI. Methods: Of the 8049 Medicare beneficiaries hospitalized for HF and discharged alive from 106 U.S. hospitals (1998-2001), 6854 had data on admission, discharge, and highest serum creatinine, of which 2180 had AKI (a rise in admission serum creatinine by ≥0.3 mg/dL) and of these 1171 (54%) received a discharge prescription for ACEIs or ARBs. Using propensity scores for ACEI or ARB use, we assembled a matched cohort of 755 pairs of patients balanced on 33 baseline characteristics including baseline serum creatinine and rise of serum creatinine. Results: 30-day all-cause readmission occurred in 21% and 27% of matched patients receiving and not receiving ACEIs or ARBs, respectively (HR, 0.77; 95% CI, 0.62-0.95; p=0.015). 30-day HF readmission occurred in 6% and 11% of matched patients receiving and not receiving ACEIs or ARBs, respectively (HR, 0.53; 95% CI, 0.37-0.76; p=0.001). 30-day all-cause mortality occurred in 5% and 9% of matched patients receiving and not receiving ACEIs or ARBs, respectively (HR, 0.89; 95% CI, 0.79-1.00; p=0.052). Both readmission and mortality benefits persisted for 12 months post-discharge (Figure). Conclusions: Among patients hospitalized for HF who developed AKI after hospital admission, discharge prescription of ACEIs or ARBs was associated with significant short- and long-term improvements in outcomes.