Of the 1340 patients (age ¡Ý 65 years) with diastolic heart failure (ejection fraction ¡Ý 45 % ) and chronic kidney disease (estimated glomerular filtration rate < 60 mL/min/1.73 m2), 717 received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Propensity scores for the use of these drugs, estimated for each of the 1340 patients, were used to assemble a cohort of 421 pairs of patients, receiving and not receiving these drugs, who were balanced on 56 baseline characteristics.
During more than 8 years of follow-up, all-cause mortality occurred in 63 % and 69 % of matched patients with chronic kidney disease receiving and not receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, respectively (hazard ratio [HR], 0.82; 95 % confidence interval [CI], 0.70-0.97; P = .021). There was no association with heart failure hospitalization (HR, 0.98; 95 % CI, 0.82-1.18; P = .816). Similar mortality reduction (HR, 0.81; 95 % CI, 0.66-0.995; P = .045) occurred in a subgroup of matched patients with an estimated glomerular filtration rate less than 45 mL/min/1.73 m2. Among 207 pairs of propensity-matched patients without chronic kidney disease, the use of these drugs was not associated with mortality (HR, 1.03; 95 % CI, 0.80-1.33; P = .826) or heart failure hospitalization (HR, 0.99; 95 % CI, 0.76-1.30; P = .946).
A discharge prescription for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant reduction in all-cause mortality in older patients with diastolic heart failure and chronic kidney disease, including those with more advanced chronic kidney disease.