Survival Benefits of Angiotensin‐Converting Enzyme Inhibitors in Older Heart Failure Patients with Perceived Contraindications

Abstract

ACE inhibitor use was associated with a significant survival benefit in this cohort of hospitalized older heart failure patients with perceived contraindications.

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

“…651 In an observational study of elderly (mean age 79 years) hospitalized patients with acute systolic HF and advanced CKD (mean serum creatinine 2.9 mg/dL), ACEI use was associated with a 31% absolute mortality reduction. 652 …”

Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management

“…Observational data suggest that ACE inhibitor use in elderly heart failure patients may preserve cognition, slow functional decline, and reduce hospitalizations and perhaps even mortality, even in patients with relative contraindications, such as mild to moderate renal impairment (137)(138)(139). The beta-blocker nebivolol has been studied in 2128 patients 70 years of age or older with clinical evidence of heart failure regardless of ejection fraction (140).…”

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

“…In fact, it makes sense to be expected that RAAS blockers, which are the cornerstones of treatment in HF, affect prognosis favorably in patients who have HF in association with CRD. Based on the results of retrospective studies (163,164), expert opinions (165) and KDIGO recommendations (166), it has been pointed out that these patients may benefit from RAAS blockers with appropriate follow-up. In a recent prospective cohort analysis, it has been reported that in HF patients with severe renal disease (creatinine clearance <30 mL/min, Stage 4-5 CRD), RAAS blockers reduced all-cause mortality (167 *Blood urea nitrogen/creatinine ratio (BUN/Cre) is commonly used to differentiate pre-renal failure from the underlying renal disease.…”