062: Treatment of heart failure in the real life: clinical inertia early after discharge worsens outcome

Berthelot-Garcias, Emmanuelle; Isnard, R.; Damy, Thibaud; Donal, Erwan; Galinier, Michel; Trochu, Jean‐Noël; Dujardin, J.-J.; Mulak, Geneviève; Logeart, Damien

doi:10.1016/s1878-6480(13)70992-3

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“…Acute discontinuation of GDMT has been associated with reduced survival in patients hospitalized with decompensated HFrEF, 15 possibly because patients are discharged prior to therapy optimization. 16 Non-persistence with HF therapy is also associated with an increased risk of hospitalization. 17 Previous research investigating ACE-I/ARB management in CRS is limited.…”

Section: Discussionmentioning

confidence: 99%

Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Renal Function in Type 1 Cardiorenal Syndrome

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et al. 2021

J Cardiovasc Pharmacol Ther

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Introduction: Angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin receptor blocker (ARB) discontinuation during acute heart failure (AHF) is associated with increased mortality following hospitalization. Although the etiology of acute kidney injury (AKI) in type 1 cardiorenal syndrome (CRS) has been linked to renal venous congestion, ACE-I/ARB withdrawal (AW) theoretically promotes renal function recovery. ACE-I/ARBs are dose-reduced or withheld in approximately half of patients with CRS, but the subsequent impact on renal function remains largely uninvestigated. This study compared AW to ACE-I/ARB continuation (AC) during CRS. Methods: This was a retrospective, single-center chart review. Patients aged 18-89 years admitted from April 2018 to August 2019 with AHF and AKI were identified using discharge ICD-10 codes. All patients were treated with an ACE-I/ARB before admission. Key exclusion criteria included shock, pregnancy, and end-stage renal disease. The primary endpoint was change in serum creatinine (SCr) from admission through 72 hours. Data were analyzed utilizing chi-square and Mann-Whitney U tests with SPSS software. Results: A total of 111 admissions were included. AW occurred in 68 patients upon admission. AW patients presented with a higher blood urea nitrogen ( P = 0.034), higher SCr ( P = 0.021), and lower ejection fraction ( P = 0.04). Median SCr change from admission to 72 hours did not differ between groups (AW −0.1 mg/dL vs AC 0.0 mg/dL, P = 0.05). There was no difference in SCr reduction ≥0.3 mg/dL at 72 hours, 30-day readmissions, or ACE-I/ARB prescription at discharge. Conclusions: In patients with type 1 CRS, AW was not associated with improved renal function at 72 hours. A larger sample size is necessary to confirm these results.

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Section: Discussionmentioning

confidence: 99%