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

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Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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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Acknowledgments

We thank the participants of the study.

Funding

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

Authorship

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.

Disclosures

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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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, South Korea

    Hyun-Jin Kim

  2. Division of Cardiology/Cardiovascular Center, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, South Korea

    Sang-Ho Jo

  3. Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea

    Min-Ho Lee

  4. Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea

    Won-Woo Seo

  5. Division of Cardiology, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Jin-Oh Choi

  6. Department of Cardiovascular Medicine, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwasung, South Korea

    Kyu-Hyung Ryu

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  1. Hyun-Jin Kim
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Corresponding author

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). https://doi.org/10.1007/s12325-020-01443-6

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  • DOI: https://doi.org/10.1007/s12325-020-01443-6

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