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Association between renin-angiotensin system inhibitor use and mortality/morbidity in elderly patients with heart failure with reduced ejection fraction: a prospective propensity score matched cohort study
Karolinska Inst, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0001-6353-8041
Vaxjo Hosp, Sweden.
Univ Michigan, MI 48109 USA.
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2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 48, p. 4257-4265Article in journal (Refereed) Published
Abstract [en]

Aims In heart failure with reduced ejection fraction (HFrEF), renin angiotensin system inhibitors (RASi) improve morbidity and mortality. However, patients aged amp;gt;80 years constituted a small minority in trials. We assessed the association between RASi use and mortality/morbidity in HFrEF patients aged amp;gt;80 years. Methods and results We included patients with ejection fraction amp;lt;40% and age amp;gt;80 years from the Swedish Heart Failure Registry. Propensity scores for RASi use were calculated from 37 variables. Cox regression models for RASi vs. non-RASi with all-cause mortality and all-cause mortality/heart failure (HF) hospitalization as outcomes were fitted in a 1:1 propensity-score-matched cohort. To assess consistency, the same analyses were performed in a positive control cohort aged amp;lt;= 80 years. Of 6710 patients [median age (interquartile range) 85 (82-87) years; 38% women], 5384 (80%) received RASi. Propensity-score matching yielded 2416 patients, [age 86 (83-91) years]. RASi use was associated with hazard ratio (HR) (95% confidence interval) 0.78 (0.72-0.86) for all-cause mortality and 0.86 (0.79-0.94) for all-cause mortality/HF hospitalization. In positive control patients aged amp;lt;= 80 years (17 842 patients in the overall cohort, 2126 after matching), HR for all-cause mortality was 0.81 (0.71-0.91), whereas it was 0.85 (0.76-0.94) for all-cause mortality/HF hospitalization. Conclusion In HFrEF patients with age amp;gt;80years, RASi were relatively underused compared with in younger patients, despite similar association with reduced morbidity and mortality and no apparent association with risk of syncope-related hospitalization. These results may be interpreted as hypothesis generating for randomized clinical trials on RASi in this elderly HFrEF subpopulation.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS , 2018. Vol. 39, no 48, p. 4257-4265
Keywords [en]
Heart failure; Elderly; Renin angiotensin system inhibitor; ACE inhibitor; Angiotensin receptor blocker; Registry
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-154726DOI: 10.1093/eurheartj/ehy621ISI: 000456855600011PubMedID: 30351407OAI: oai:DiVA.org:liu-154726DiVA, id: diva2:1292258
Note

Funding Agencies|Swedish Research Council [2013-23897-104604-23, 523-2014-2336]; Swedish Heart Lung Foundation [20120321, 20150557]

Available from: 2019-02-27 Created: 2019-02-27 Last updated: 2019-02-27

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Dahlström, Ulf
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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CiteExportLink to record
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