Renin-Angiotensin System Inhibitors Prognostic Benefit in Older Patients with Atrial Fibrillation

Abstract

ObjectivesAngiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) have shown antiarrhythmic effects that are useful as part of the upstream therapy for atrial fibrillation (AF), both for primary and secondary prevention. Nevertheless, the potential prognosis value of these drugs in terms of mortality and major cardiovascular events is unclear, especially in older population with AF. Scientific evidence is scarce in this population and shows contradictory results. The aim of this study was to assess the potential benefit of ACEi and ARB in terms of mortality and major cardiovascular outcomes (hospitalization for heart failure, acute myocardial infarction and stroke) in older patients with AF, based on a real-world data analysis. DesignObservational: analysis of a retrospective registry. Settings and ParticipantsThe study included 9365 patients of 75 years or older diagnosed with AF, from CardioCHUVI-AF_75 registry: ClinicalTrials.gov Identifier: NCT04364516. Date of registration: November 26, 2018. MethodsWe performed propensity score matching techniques to obtain 2 comparable groups of 3601 patients with and without ACEi or ARB treatment. We compared survival and cardiovascular outcomes in both groups of patients using Cox proportional hazards models. ResultsWe did not find significant differences in terms of survival between using or not using ACEi or ARB for the older population (hazard ratio for mortality: 0.959, 95% confidence interval 0.872–1.054). There were no significant differences regarding cardiovascular major events between the 2 groups. Conclusions and ImplicationsTreatment with ACEi or ARB did not improve outcomes in terms of survival and cardiovascular events in older patients with AF. These results should prompt the conduct of randomized clinical trials specifically in the older AF patient population to robustly address this issue.