Heart Failure Patients Receiving ACEIs/ARBs were Less Likely to be Hospitalized or to Use Emergency Care in the Following Year

Abstract

Angiotensin-converting enzyme inhibitors (ACEIs) have been shown to decrease morbidity and mortality in heart failure (HF) patients in randomized-controlled trials; observational studies have confirmed this benefit among patients discharged with HF. Investigating the benefit of ACEIs or angiotensin receptor blockers (ARBs) among general HF patients has important implications for quality-of-care measurement and quality initiatives. The objective of this study is to assess the impact of receipt of ACEIs/ARBs among patients with HF on hospitalization, emergency care, and healthcare cost during the following year. Using administrative data, we identified HF patients between 2000 and 2005 in a large health plan (n=2,396 patients). We conducted multivariate analysis to assess the impact of receipt of an ACEI/ARB on likelihood of hospitalization and emergency care, and on total healthcare cost. We found that patients who received ACEIs/ARBs were less likely to be hospitalized (odds ratio [OR]=0.82, p<.05) or use emergency care (OR=0.82, p<.05) in the following year. Receipt of ACEIs/ARBs was not associated with significantly increased cost. Incentivizing the receipt of ACEIs/ARBs in a general population with HF may be a suitable target for pay-for-performance programs, disease management programs, or newer complementary frameworks, such as value-based insurance design.

A Reevaluation of the Costs of Heart Failure and Its Implications for Allocation of Health Resources in the United States

“…As mentioned above, because these costs vary widely in the literature, a number of reports/studies on annual medication costs were reviewed to determine how these costs should best be calculated. Studies that evaluated costs for HF‐related cardiovascular medications (ie, those directly attributable to the HF condition) were evaluated to determine consistency of finding. A range of costs was then used.…”

The impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on the mortality in sepsis: A systematic review and meta-analysis

“…ACE inhibitors and ARBs reduce blood pressure by vasodilation, decreasing angiotensin II formation, and kallikrein degradation to reduce sodium and water retention [27]. These effects can also decrease the glomerular filtration rate (GFR) since angiotensin II plays a critical role in the maintenance of GFR, especially during hypovolemia or hypotension [28,29]. In the guidelines for sepsis treatment, the maintenance of a certain tissue perfusion pressure is necessary; however, the use of ACE inhibitors and ARBs appear to be contrary to the recommended treatment guidelines for sepsis.…”

“…Moreover, ACE inhibitors and ARBs have not been recommended as a therapeutic drug in previous septic diagnosis and treatment guidelines. In addition to the effect of lowering blood pressure, both ACE inhibitors and ARBs also have anti-inflammatory effects, which can reduce plasma cytokine and nitric oxide concentrations [28,29]. In septic animal models, although ACE inhibitors have been demonstrated to reduce organ damage through the NF-κB signaling pathway [31], conflicting data exist regarding to whether an angiotensin II blockade improves survival in animal models [32,33].…”