RAS inhibitors proven beneficial in HFrEF with advanced kidney disease

Use of renin-angiotensin system (RAS) inhibitors results in improved clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and advanced kidney disease, a study has shown.

A total of 1,582 patients with HFrEF (ejection fraction ≤40 percent) had advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m²) in the OPTIMIZE-HF* study. Of these, 829 were not treated with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) prior to admission. Among these patients, 214 were initiated on these drugs before discharge.

The investigators calculated propensity scores for receipt of these medications for each of the 829 patients and assembled a matched cohort of 388 individuals. They were balanced on 47 baseline characteristics (mean age 78 years, 52 percent women, 10 percent African American, 73 percent receiving beta-blockers).

Finally, the investigators calculated the hazard ratios (HRs) and 95 percent confidence intervals (CIs) to compare 2-year outcomes between 194 patients initiated on ACE inhibitors or ARBs and 194 participants not initiated on these drugs.

The combined endpoint of heart failure readmission or all-cause mortality occurred in 79 percent of patients initiated on ACE inhibitors or ARBs and in 84 percent of those not initiated (HR, 0.79, 95 percent CI, 0.63‒0.98). For the individual endpoints, the HRs were 0.81 (95 percent CI, 0.63‒1.03) for all-cause mortality and 0.63 (95 percent CI, 0.47‒0.85) for heart failure readmission.

“These hypothesis-generating findings need to be replicated in contemporary patients,” the investigators said.

*Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure