Effects of combined renin–angiotensin–aldosterone system inhibitor and beta‐blocker treatment on outcomes in heart failure with reduced ejection fraction: insights from BIOSTAT‐CHF and ASIAN‐HF registries

Abstract

Background Angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) and-blockers are guideline-recommended first-line therapies in heart failure (HF) with reduced ejection fraction (HFrEF). Previous studies showed that individual drug classes were under-dosed in many parts of Europe and Asia. In this study, we investigated the association of combined up-titration of ACEi/ARBs and-blockers with all-cause mortality and its combination with hospitalization for HF.

A Novel Approach to Medical Management of Heart Failure With Reduced Ejection Fraction

“…70 Retrospective analysis of the Biology Study to Tailored Treatment in Chronic Heart Failure (BIOSTAT-CHF) and Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) registries, conducted by Ouwerkerk et al, sought to determine the relationship between ACEI and bblocker doses and subsequent outcomes. 71 In their analysis, increasing ACEI dose was associated with reduction in hospitalizations but not mortality, whereas increasing b-blocker dose was associated with greater reduction in mortality and increase in hospitalizations. 71 Importantly, low doses of both drugs (< 50% target dose for both) was associated with improved outcomes compared with target dose of ACEI or bblocker alone.…”

“…71 In their analysis, increasing ACEI dose was associated with reduction in hospitalizations but not mortality, whereas increasing b-blocker dose was associated with greater reduction in mortality and increase in hospitalizations. 71 Importantly, low doses of both drugs (< 50% target dose for both) was associated with improved outcomes compared with target dose of ACEI or bblocker alone.…”

March 2021 at a glance: focus on epidemiology, prevention and COVID‐19

“…These findings could be helpful to refine ACEi/ARB and β-blocker up-titration in patients with HF. 17…”

August 2020 at a glance: focus on neurohormonal antagonists and electrolytes

“…Adherence to guideline‐directed medical therapy is associated with better outcome in HFrEF patients 23,24 . Ouwerkerk et al 25 . analysed the effects of combined up‐titration of angiotensin‐converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) and β‐blockers with all‐cause mortality and hospitalization for HF in patients enrolled in the BIOlogy Study to TAilored Treatment in Chronic HF (BIOSTAT‐CHF) and Asian Sudden Cardiac Death in HF (ASIAN‐HF) registries.…”

“…analysed the effects of combined up‐titration of angiotensin‐converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) and β‐blockers with all‐cause mortality and hospitalization for HF in patients enrolled in the BIOlogy Study to TAilored Treatment in Chronic HF (BIOSTAT‐CHF) and Asian Sudden Cardiac Death in HF (ASIAN‐HF) registries. The best outcomes were observed in patients achieving the guideline‐recommended target doses for both ACEi/ARBs and β‐blockers (hazard ratio 0.32, 95% confidence interval 0.26–0.39) 25 …”