Abstract
Background : Angiotensin-converting enzyme inhibitors (ACEI) should be titrated to the optimal dose for adequate inhibition of the Renin-Angiotensin-Aldosterone system (RAAS). The up-titration of ACEI to the optimal doses during in-hospital treatment is challenging. Objectives : This study aimed to investigate whether the use of optimal dose of ACEI during in-hospital treatment could give more benefit to the outcome of heart failure (HF) patients. Methods : We involved 171 HF patients in this prospective cohort study. 29 and 142 HF patients were treated with optimal dose and suboptimal dose of ACEI during in-hospital treatment, respectively. The primary endpoint was in-hospital and 30 days post-discharge mortality. The secondary endpoint was 30 days post-discharge rehospitalization due to worsening of HF. Results: Only 17% of HF patients treated with optimal dose of ACEI during in-hospital treatment. In-hospital mortality in optimal dose of ACEI group was lower than in suboptimal dose of ACEI group (0% vs. 19.7%; p = 0.009). The 30 days post-discharge mortality (0% vs 2.7%; p = 0.375) and rehospitalization (6.9% vs 16.7%; p = 0.184) between both groups were not significantly different. Conclusion: The use of optimal dose of ACEI during in-hospital treatment reduced in-hospital mortality in HF patients.
Highlights
heart failure (HF) patients suffered from decreased quality of life, intolerance to physical activity, frequent hospital admission, and increased mortality.[1,2] The latest data revealed that one-year all-cause mortality rates for ambulatory and hospitalized HF patients were 7% and 17%, respectively.[2]
This study aimed to investigate whether the use of optimal dose of Angiotensin-converting enzyme inhibitors (ACEI) during in-hospital treatment could give more benefit to the outcome of heart failure (HF) patients
Of 171 patients who involved in this study, 29 (17%) patients and 142 (83%) patients were treated with optimal doses and suboptimal dose of ACEI during in-hospital treatment, respectively (See Figure 1)
Summary
HF patients suffered from decreased quality of life, intolerance to physical activity, frequent hospital admission, and increased mortality.[1,2] The latest data revealed that one-year all-cause mortality rates for ambulatory and hospitalized HF patients were 7% and 17%, respectively.[2]. Renal dysfunction was a major limitation of ACEI up-titration, in addition to hypotension, electrolyte disturbances, and low compliance levels.[10,11] few studies have compared optimal vs suboptimal of ACEI on mortality and morbidity for HF patients.[10,12,13] This study aimed to investigate whether the use of optimal dose of ACEI during in-hospital treatment could give more benefit to the outcome of HF patients. Objectives : This study aimed to investigate whether the use of optimal dose of ACEI during in-hospital treatment could give more benefit to the outcome of heart failure (HF) patients. Conclusion: The use of optimal dose of ACEI during in-hospital treatment reduced in-hospital mortality in HF patients
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