Renin-Angiotensin Inhibition and Outcomes in Nursing Home Residents With Heart Failure.

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Citation: American Journal of Therapeutics. 27(3):e235-e242, 2020 May/Jun.PMID: 30299270Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Angiotensin Receptor Antagonists/tu [Therapeutic Use] | *Angiotensin-Converting Enzyme Inhibitors/tu [Therapeutic Use] | *Heart Failure/dt [Drug Therapy] | *Nursing Homes/sn [Statistics & Numerical Data] | Aged | Aged, 80 and over | Alabama/ep [Epidemiology] | Drug Therapy, Combination/mt [Methods] | Female | Heart Failure/mo [Mortality] | Humans | Kaplan-Meier Estimate | Male | Patient Readmission/sn [Statistics & Numerical Data] | Registries/sn [Statistics & Numerical Data] | Treatment OutcomeYear: 2020Local holdings: Available online from MWHC library: 2001 - presentISSN:
  • 1075-2765
Name of journal: American journal of therapeuticsAbstract: BACKGROUND: Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs-ARBs) improve outcomes in heart failure (HF). Less is known about this association in nursing home (NH) residents.CONCLUSIONS: We found no evidence that the use of ACEIs or ARBs is associated with improved outcomes in patients with HF in the NH setting. However, we also found evidence that this association is different in NH residents with HF versus other patients with HF. Future larger studies are needed to demonstrate effectiveness of these drugs in the NH setting.METHODS: Of the 8024 hospitalized HF patients, 542 were NH residents, of whom 252 received ACEIs-ARBs. We assembled a propensity score-matched cohort of 157 pairs of NH residents receiving and not receiving ACEIs-ARBs balanced on 29 baseline characteristics (mean age, 3 years, 74% women, 17% African American), in which we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with ACEI-ARB use. We then checked for interaction in a matched cohort of 5130 patients (378 were NH residents) assembled from 8024 patients.RESULTS: Among 314 matched NH residents, HRs (95% CIs) for 30-day all-cause readmission, HF readmission, and all-cause mortality were 0.78 (0.47-1.28), 0.68 (0.29-1.60), and 1.26 (0.70-2.27), respectively. Respective HRs (95% CIs) at 1 year were 0.76 (0.56-1.02), 0.68 (0.42-1.09), and 1.04 (0.78-1.38). Among 5130 matched patients, ACEI-ARB use was associated with a significantly lower risk of all outcomes at both times, with no significant interactions, except for 1-year mortality (P for interaction, 0.026).All authors: Ahmed A, Allman RM, Arundel C, Faselis C, Fonarow GC, Jones LG, Jurgens CY, Lam PH, Mohammed SF, Morgan CJ, Sheriff HMOriginally published: American Journal of Therapeutics. 2018 Sep 25Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2018-11-02
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30299270 Available 30299270

Available online from MWHC library: 2001 - present

BACKGROUND: Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs-ARBs) improve outcomes in heart failure (HF). Less is known about this association in nursing home (NH) residents.

CONCLUSIONS: We found no evidence that the use of ACEIs or ARBs is associated with improved outcomes in patients with HF in the NH setting. However, we also found evidence that this association is different in NH residents with HF versus other patients with HF. Future larger studies are needed to demonstrate effectiveness of these drugs in the NH setting.

METHODS: Of the 8024 hospitalized HF patients, 542 were NH residents, of whom 252 received ACEIs-ARBs. We assembled a propensity score-matched cohort of 157 pairs of NH residents receiving and not receiving ACEIs-ARBs balanced on 29 baseline characteristics (mean age, 3 years, 74% women, 17% African American), in which we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with ACEI-ARB use. We then checked for interaction in a matched cohort of 5130 patients (378 were NH residents) assembled from 8024 patients.

RESULTS: Among 314 matched NH residents, HRs (95% CIs) for 30-day all-cause readmission, HF readmission, and all-cause mortality were 0.78 (0.47-1.28), 0.68 (0.29-1.60), and 1.26 (0.70-2.27), respectively. Respective HRs (95% CIs) at 1 year were 0.76 (0.56-1.02), 0.68 (0.42-1.09), and 1.04 (0.78-1.38). Among 5130 matched patients, ACEI-ARB use was associated with a significantly lower risk of all outcomes at both times, with no significant interactions, except for 1-year mortality (P for interaction, 0.026).

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