Patterns Of Renin-Angiotensin-Aldosterone-System Inhibitor Interruption In Patients Hospitalized For Acute Decompensated Heart Failure

Abstract

Introduction It is unknown if interruption of renin-angiotensin-aldosterone system inhibitors (RAASi) in acute decompensated heart failure (ADHF) impacts future use. Objectives We investigated the frequency and clinical predictors of RAASi interruption in patients with heart failure reduced ejection fraction (EF) during ADHF hospitalization and its impact on chronic therapy. Methods We conducted a retrospective chart review of patients hospitalized for ADHF at our facility with an EF < 40%, on stable RAASi 1 month prior to admission, and evidence of fluid overload. Patient demographics, clinical characteristics, and RAASi use at discharge, 30, and 90 days were compared between patients whose RAASi was continued (RAASi-C) vs interrupted (RAASi-I). Rehospitalizations and death at 30 days were also compared between groups. Results 189 patients were included, mean age was 62±14 years, 53% were male, and 73% were Black. RAASi were interrupted in 56 (30%) patients during the hospital stay. The RAASi-I group had higher serum creatinine (SCr) (2.6 vs 1.5 mg/dL, p=0.003), greater increase in SCr from baseline (0.53 vs 0.01 mg/dL, p=0.001), higher potassium (4.5 vs 4.2 mEq/L, p=0.001), and lower blood pressure (BP) (systolic: 126 vs 138 mmHg, p=0.01; diastolic 73 vs 81mmHg, p=0.007). Logistic regression identified SCr, potassium, and diastolic BP on admission as significant predictors of RAASi interruption. RAASi use at discharge, 30, and 90 days was lower in the RAASi-I group (Table 1). Compared to the RAASi-C group, more patients in the RAASi-I group were re-hospitalized at 30 days (45% vs 27%, p=0.014); deaths at 30 days were similar between groups (3.8% vs 1.8% p=0.486). Conclusions: Increased SCr, higher potassium, and lower diastolic BP are significant predictors of RAASi interruption during an ADHF hospitalization. RAASi interruption was associated with decreased RAASi use through the first 90 days after discharge and higher 30-day rehospitalization. It is unknown if interruption of renin-angiotensin-aldosterone system inhibitors (RAASi) in acute decompensated heart failure (ADHF) impacts future use. We investigated the frequency and clinical predictors of RAASi interruption in patients with heart failure reduced ejection fraction (EF) during ADHF hospitalization and its impact on chronic therapy. We conducted a retrospective chart review of patients hospitalized for ADHF at our facility with an EF < 40%, on stable RAASi 1 month prior to admission, and evidence of fluid overload. Patient demographics, clinical characteristics, and RAASi use at discharge, 30, and 90 days were compared between patients whose RAASi was continued (RAASi-C) vs interrupted (RAASi-I). Rehospitalizations and death at 30 days were also compared between groups. 189 patients were included, mean age was 62±14 years, 53% were male, and 73% were Black. RAASi were interrupted in 56 (30%) patients during the hospital stay. The RAASi-I group had higher serum creatinine (SCr) (2.6 vs 1.5 mg/dL, p=0.003), greater increase in SCr from baseline (0.53 vs 0.01 mg/dL, p=0.001), higher potassium (4.5 vs 4.2 mEq/L, p=0.001), and lower blood pressure (BP) (systolic: 126 vs 138 mmHg, p=0.01; diastolic 73 vs 81mmHg, p=0.007). Logistic regression identified SCr, potassium, and diastolic BP on admission as significant predictors of RAASi interruption. RAASi use at discharge, 30, and 90 days was lower in the RAASi-I group (Table 1). Compared to the RAASi-C group, more patients in the RAASi-I group were re-hospitalized at 30 days (45% vs 27%, p=0.014); deaths at 30 days were similar between groups (3.8% vs 1.8% p=0.486). Conclusions: Increased SCr, higher potassium, and lower diastolic BP are significant predictors of RAASi interruption during an ADHF hospitalization. RAASi interruption was associated with decreased RAASi use through the first 90 days after discharge and higher 30-day rehospitalization.