Mortality and morbidity of non-systolic heart failure treated with angiotensin-converting enzyme inhibitors: a propensity-adjusted case-control study.

Abstract

BACKGROUND:

The effect of treatment with angiotensin-converting enzyme inhibitors (ACEIs) on the prognosis of patients newly diagnosed with heart failure with preserved systolic function (HF-PSF) is unclear. We evaluate the relationship of commencing ACEI therapy (C-ACEI-T) with the morbidity and mortality of patients with HF-PSF.

METHODS:

Prospective propensity-adjusted cohort study over 5 years on 1120 adults diagnosed with HF-PSF for the first time, within an integrated health organization in Spain. We analyzed the independent relationship between C-ACEI-T and mortality, and morbidity, stratifying patients according to comorbidity, after a multivariable adjustment for potential confounders.

RESULTS:

The 865 patients (77.2%) who C-ACEI-T were younger, with more cardiovascular comorbidity. During the median follow-up of 908.3 days (interquartile range 558.6-1302.0) 580 patients (51.8%) died, and 727 (64.9%) were hospitalized. Using an intention-to-treat analysis, C-ACEI-T was associated with a lower risk of all-cause (RR [CI 95%] 0.34 [0.23 to 0.46]), and cardiovascular (RR 0.28 [0.20 to 0.36]) mortality, and a lower age- and sex-adjusted rate of hospitalization (per 100 persons-year), 12.3 vs. 19.4, (P<0.001 in all cases), even after adjustment for the propensity to take ACEIs, or other medications, comorbidities, and other potential confounders.

CONCLUSION:

In this prospective observational study the establishment of ACEI therapy is associated with a reduced mortality and morbidity of patients with newly diagnosed non-systolic heart failure.

• Authors: Francisco M Gomez-Soto, Sotero P Romero, Jose A Bernal, Miguel A Escobar, Jose L Puerto, Jose L Andrey, Jose Almenara, Francisco Gomez
• Journal: International journal of cardiology (Int J Cardiol) Vol. 139 Issue 3 Pg. 276-82 (Mar 18 2010) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 19064293 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Angiotensin-Converting Enzyme Inhibitors

Topics

• Aged
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Case-Control Studies
• Cohort Studies
• Female
• Follow-Up Studies
• Heart Failure (drug therapy, mortality)
• Humans
• Male
• Middle Aged
• Morbidity
• Propensity Score
• Prospective Studies
• Systole (drug effects, physiology)
• Treatment Outcome