Background: In hospitalized patients with acute heart failure (AHF), safety and prognostic impact of starting angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) in very acute phase has not been well elucidated.
Methods: We utilized REALITY-AHF data in which 1682 patients hospitalized for AHF were registered. Patients not treated with ACEI/ARB at admission were eligible, and were divided into two groups: patients treated with ACEI/ARB (ACEI/ARB group) and without ACEI/ARB (non-ACEI/ARB group) within 48 hours of presentation to the hospital. Primary endpoint was a composite of 1-year mortality and hospitalization for AHF. Worsening renal function (WRF) (creatinine increase ≥0.3 mg/dL and ≥25% in 5 days) and length of hospital stay were also evaluated.
Results: Among 900 AHF patients not treated with ACEI/ARB at admission, 288 patients were in ACEI/ARB group and 612 patients were in Non-ACEI/ARB group. There were no significant differences in the incidence of WRF (14.7 vs. 17.1% for ACEI/ARB group and non-ACEI/ARB group, respectively; P=0.367) and the length of hospital stay (median 16 days for both ACEI/ARB group and non-ACEI/ARB group, P=0.152). In Kaplan-Meier analysis, ACEI/AEB group was associated with better outcome compared to non-ACEI/ARB group (Log-rank: P < 0.001), and this association was retained in multivariable analysis (HR 0.72, P=0.036) even after adjustment for other covariates. We also conducted propensity score matching, and well balanced two groups including 312 patients were generated. Again, there was no difference in incidence of WRF and length of hospital stay, and ACEI/ARB group was associated with better prognosis compared to non-ACEI/ARB group in both Kaplan-Meier analysis (Log-rank: P=0.009) and Cox regression analysis (HR 0.54, P=0.011)
Conclusions: In hospitalized AHF patients, early initiation of ACEI/ARB within 48hours of admission is safe and contributes to better 1-year outcome.