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Effect of Prescribing Patterns of Renin–Angiotensin System Blockers and Beta-Blockers on Prognosis of Heart Failure



Use of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) only, beta-blockers (BB) only, or both has been rarely compared in patients with heart failure (HF). We evaluated the prescribing patterns of ACEi/ARB and BB on prognosis in HF according to left ventricular function.


Study data were obtained from a national multicenter cohort that included patients hospitalized for HF. Patients were classified into four groups according to the prescription pattern at discharge: all ACEi/ARB and BB treatment group, only ACEi or ARB treatment group, only BB treatment group, and neither ACEi/ARB nor BB group.


Use of both ACEi/ARB and BB had significantly lowest all-cause death rates among the four groups in all types of HF. Cox regression analysis showed that use of both drugs was independently associated with 51% reduced risk of all-cause death in patients with HF with preserved ejection fraction (HFpEF) and HF with mid-range ejection fraction (HFmrEF). Treatment with only ACEi/ARB also showed an independent association with a 52% reduction in this group. However, only BB treatment was not associated with reducing long-term mortality in patients with HFpEF and HFmrEF. In patients with HF with reduced ejection fraction, use of ACEi/ARB and/or BB revealed an independent association with a reduced risk of all-cause death regardless of prescribing patterns.


Prescribing patterns were diverse in HF and there was a difference in the degree of risk reduction in all-cause death. In particular, clinicians should consider ACEi/ARB first for patients with HFpEF and HFmrEF prior to BB.

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We thank the participants of the study.


No funding or sponsorship was received for this study or publication of this article.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.


Hyun-Jin Kim, Sang-Ho Jo, Min-Ho Lee, Won-Woo Seo, Jin-Oh Choi and Kyu-Hyung Ryu have nothing to disclose.

Compliance with Ethics Guidelines

The study protocol complied with the Declaration of Helsinki 1964 and its later amendments and was reviewed and approved by the Institutional Review Board of Konkuk University Hospital (reference no. KUH 1010270) and each participating hospital. All patients provided written informed consent prior to participation in the study.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Correspondence to Sang-Ho Jo.

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Kim, HJ., Jo, SH., Lee, MH. et al. Effect of Prescribing Patterns of Renin–Angiotensin System Blockers and Beta-Blockers on Prognosis of Heart Failure. Adv Ther 37, 3839–3849 (2020).

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  • Angiotensin-converting enzyme inhibitor
  • Angiotensin receptor blockers
  • Beta-blocker
  • Ejection fraction
  • Heart failure