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Angiotensin receptor blockers and outcomes in real‐world older patients with heart failure and preserved ejection fraction: a propensity‐matched inception cohort clinical effectiveness study
Author(s) -
Patel Kanan,
Fonarow Gregg C.,
Kitzman Dalane W.,
Aban Inmaculada B.,
Love Thomas E.,
Allman Richard M.,
Gheorghiade Mihai,
Ahmed Ali
Publication year - 2012
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfs101
Subject(s) - medicine , hazard ratio , ejection fraction , heart failure , propensity score matching , confidence interval , clinical endpoint , cardiology , proportional hazards model , cohort , cohort study , clinical trial
Aims To examine the clinical effectiveness of angiotensin receptor blockers (ARBs) in older patients with heart failure and preserved ejection fraction (HF‐PEF). Methods and results Of the 10 570 hospitalized HF‐PEF patients, aged ≥65 years, EF ≥40%, in OPTIMIZE‐HF (2003–2004), linked to Medicare data (up to 31 December 2008), 3806 were not receiving angiotensin‐converting enzyme inhibitors or prior ARB therapy. Of these, 303 (8%) patients received new discharge prescriptions for ARBs. Propensity scores for the receipt of ARBs, estimated for each of the 3806 patients, were used to assemble a cohort of 296 pairs of patients receiving and not receiving ARBs, who were balanced on 114 baseline characteristics. Patients had a mean age of 80 years, mean EF of 55%, 69% were women, and 12% were African American. During 6 years of follow‐up, the primary composite endpoint of all‐cause mortality or HF hospitalization occurred in 79% (235/296) and 81% (241/296) of patients receiving and not receiving ARBs, respectively [hazard ratio (HR) associated with ARB use 0.88, 95% confidence interval (CI) 0.74–1.06; P = 0.179]. ARB use had no association with individual endpoints of all‐cause mortality (HR 0.93, 95% CI 0.76–1.14; P = 0.509), HF hospitalization (HR 0.90, 95% CI, 0.72–1.14; P = 0.389), or all‐cause hospitalization (HR 0.91, 95% CI 0.77–1.08; P = 0.265). These associations remained unchanged when we compared any (prevalent and new prescriptions) ARB use vs. non‐use in a separately assembled propensity‐matched cohort of 1137 pairs of HF‐PEF patients. Conclusions In real‐world older HF‐PEF patients, ARB use was not associated with improved clinical outcomes.