Association between prognosis and the use of angiotensin‐converting enzyme inhibitors and/or angiotensin II receptor blockers in frail patients with heart failure with preserved ejection fraction. (24th March 2022)

• Record Type: Journal Article
• Authors: Sunaga, Akihiro; Hikoso, Shungo; Tamaki, Shunsuke; Seo, Masahiro; Yano, Masamichi; Hayashi, Takaharu; Nakagawa, Akito; Nakagawa, Yusuke; Kurakami, Hiroyuki; Yamada, Tomomi; Kitamura, Tetsuhisa; Sato, Taiki; Oeun, Bolrathanak; Kida, Hirota; Sotomi, Yohei; Dohi, Tomoharu; Okada, Katsuki; Mizuno, Hiroya; Nakatani, Daisaku; Yamada, Takahisa; Yasumura, Yoshio; Sakata, Yasushi
• Other Names: Seo Masahiro investigator.; Watanabe Tetsuya investigator.; Yamada Takahisa investigator.; Hayashi Takaharu investigator.; Higuchi Yoshiharu investigator.; Masuda Masaharu investigator.; Asai Mitsutoshi investigator.; Mano Toshiaki investigator.; Fuji Hisakazu investigator.; Masuda Daisaku investigator.; Tamaki Shunsuke investigator.; Shutta Ryu investigator.; Yamashita Shizuya investigator.; Sairyo Masami investigator.; Nakagawa Yusuke investigator.; Abe Haruhiko investigator.; Ueda Yasunori investigator.; Matsumura Yasushi investigator.; Nagai Kunihiko investigator.; Yano Masamichi investigator.; Nishino Masami investigator.; Tanouchi Jun investigator.; Arita Yoh investigator.; Ogasawara Nobuyuki investigator.; Ishizu Takamaru investigator.; Ichikawa Minoru investigator.; Takano Yuzuru investigator.; Rin Eisai investigator.; Shinoda Yukinori investigator.; Tachibana Koichi investigator.; Hoshida Shiro investigator.; Izumi Masahiro investigator.; Yamamoto Hiroyoshi investigator.; Kato Hiroyasu investigator.; Nakatani Kazuhiro investigator.; Yasuga Yuji investigator.; Nishio Mayu investigator.; Hirooka Keiji investigator.; Yoshimura Takahiro investigator.; Yasuoka Yoshinori investigator.; Tani Akihiro investigator.; Okumoto Yasushi investigator.; Makino Yasunaka investigator.; Onishi Toshinari investigator.; Iwakura Katsuomi investigator.; Kijima Yoshiyuki investigator.; Kitao Takashi investigator.; Kanai Hideyuki investigator.; Fujita Masashi investigator.; Harada Koichiro investigator.; Kumada Masahiro investigator.; Nakagawa Osamu investigator.; Araki Ryo investigator.; Yamada Takayuki investigator.; Nakagawa Akito investigator.; Yasumura Yoshio investigator.; Sato Taiki investigator.; Sunaga Akihiro investigator.; Oeun Bolrathanak investigator.; Kida Hirota investigator.; Sotomi Yohei investigator.; Dohi Tomoharu investigator.; Nakamoto Kei investigator.; Okada Katsuki investigator.; Sera Fusako investigator.; Kioka Hidetaka investigator.; Ohtani Tomohito investigator.; Takeda Toshihiro investigator.; Nakatani Daisaku investigator.; Mizuno Hiroya investigator.; Hikoso Shungo investigator.; Sakata Yasushi investigator.;
• Is Part Of: ESC heart failure. Volume 9:Number 3(2022)
• Page Start: 1801
• Page End: 1811
• Publication Date: 2022-03-24
• Subjects: Heart failure with preserved ejection fraction -- Clinical Frailty Scale -- ACE‐I -- ARB; Heart failure -- Periodicals; 616.129005
• DOI: 10.1002/ehf2.13873
• Languages: English
• ISSNs: 2055-5822

Abstract

Abstract: Aims: The effectiveness of angiotensin‐converting enzyme inhibitors (ACE‐I) and angiotensin II receptor blockers (ARB) has not been demonstrated in patients with heart failure with preserved ejection fraction (HFpEF). We recently reported significant interaction between the use of ACE‐I and/or ARB (ACE‐I/ARB) and frailty on prognosis in patients with HFpEF. In the present study, we examined the association between ACE‐I/ARB and prognosis in patients with HFpEF stratified by the presence or absence of frailty. Methods and results: We examined the association between the use of ACE‐I/ARB and prognosis according to the presence [Clinical Frailty Scale (CFS) ≥ 5] or absence (CFS ≤ 4) of frailty in patients with HFpEF in a post hoc analysis of registry data. Primary endpoint was the composite of all‐cause mortality and heart failure admission. Secondary endpoints were all‐cause mortality and heart failure admission. Of 1059 patients, median age was 83 years and 45% were male. Kaplan–Meier analysis showed that the risk of composite endpoint (log‐rank P = 0.001) and all‐cause death (log‐rank P = 0.005) in patients with ACE‐I/ARB was lower in those with CFS ≥ 5, but similar between patients with and without ACE‐I/ARB in patients with CFS ≤ 4 (composite endpoint: log‐rank P = 0.830; all‐cause death: log‐rank P = 0.192). In a multivariable Cox proportional hazards model, use of ACE‐I/ARB was significantly associated with lower risk of the composite endpoint [hazard ratio (HR) = 0.52, 95% confidence interval (CI) = 0.33–0.83, P = 0.005] and heart failure admission (HR = 0.45, 95% CI = 0.25–0.83, P = 0.010) in patients with CFS ≥ 5, but not in patients with CFS ≤ 4 (composite endpoint: HR = 1.41, 95% CI = 0.99–2.02, P = 0.059; heart failure admission: HR = 1.43, 95% CI = 0.94–2.18, P = 0.091). The association between ACE‐I or ARB and prognosis did not significantly differ by CFS (CFS ≤ 4: log‐rank P = 0.562; CFS ≥ 5: log‐rank P = 0.100, for with ACE‐I vs. ARB, respectively). Adjusted HRs for CFS 1–4 were higher than 1.0 but were <1.0 at CFS 5. Conclusions: In patients with HFpEF, use of ACE‐I/ARB was associated with better prognosis in patients with frailty as assessed with the CFS, but not in those without frailty.