Renin-Angiotensin System Inhibition and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries with Heart Failure

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• 作者：Kumar Sanam ; MD^a ; ¹ ; Vikas Bhatia ; MD^b ; ¹ ; Navkaranbir S. Bajaj ; MD^b ; ¹ ; Saurabh Gaba ; MD^b ; Charity J. Morgan ; PhD^b ; Gregg C. Fonarow ; MD^c ; Javed Butler ; MD^d ; Prakash Deedwania ; MD^e ; Sumanth D. Prabhu ; MD^b ; ^f ; Wen-Chih Wu ; MD^g ; Michel White ; MD^h ; Thomas E. Love ; PhDⁱ ; Wilbert S. Aronow ; MD^j ; Ross D. Fletcher ; MD^k ; Richard M. Allman ; MD^l ; Ali Ahmed ; MD ; MPH^k ; ^{aliahmedmdmph@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ACEI or ARB ; Heart failure ; Hospital readmission
• 刊名：The American Journal of Medicine
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：129
• 期：10
• 页码：1067-1073
• 全文大小：485 K

文摘

Heart failure is the leading cause for 30-day all-cause readmission, the reduction of which is a goal of the Affordable Care Act. There is a growing interest in understanding the impact of evidence-based heart failure therapy on 30-day all-cause readmission. In the current study, we examined the impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI-ARBs) on 30-day all-cause readmission in heart failure.

absSec_2">Methods

abspara0015">Of the 1384 hospitalized Medicare beneficiaries with heart failure and left ventricular ejection fraction <45% discharged alive from 106 Alabama hospitals (1998-2001) without prior ACEI-ARB use and without known contraindications to ACEI-ARB use; 734 received new predischarge prescriptions for these drugs. Using propensity scores for ACEI-ARB initiation, we assembled a matched cohort of 477 pairs of patients balanced on 32 baseline characteristics (mean age 75 years, 46% women, 26% African American).

absSec_3">Results

abspara0020">Thirty-day all-cause readmissions occurred in 18% and 24% of matched patients receiving and not receiving ACEI-ARBs, respectively (hazard ratio [HR] 0.74; 95% confidence interval [CI], 0.56-0.97; P = .030). ACEI-ARB use was also associated with lower risk of 30-day all-cause mortality (HR 0.56; 95% CI, 0.33-0.98; P = .041) and of the combined endpoint of 30-day all-cause readmission or 30-day all-cause mortality (HR 0.73; 95% CI, 0.56-0.94; P = .017). All associations remained significant at 1 year post discharge.

absSec_4">Conclusions

abspara0025">Among hospitalized patients with heart failure and reduced ejection fraction, the use of ACEI-ARBs was associated with a significantly lower risk of 30-day all-cause readmission and 30-day all-cause mortality; both beneficial associations persisted during long-term follow-up.