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Effects of angiotensin receptor blocker at discharge in patients with heart failure with reduced ejection fraction: Korean Acute Heart Failure (KorAHF) registry

 Ki Hong Choi  ;  Ga Yeon Lee  ;  Jin-Oh Choi  ;  Eun-Seok Jeon  ;  Hae-Young Lee  ;  Hyun-Jai Cho  ;  Sang Eun Lee  ;  Min-Seok Kim  ;  Jae-Joong Kim  ;  Kyung-Kuk Hwang  ;  Shung Chull Chae  ;  Sang Hong Baek  ;  Seok-Min Kang  ;  Dong-Ju Choi  ;  Byung-Su Yoo  ;  Kye Hun Kim  ;  Hyun-Young Park  ;  Myeong-Chan Cho  ;  Byung-Hee Oh 
 International Journal of Cardiology, Vol.257 : 168-176, 2018 
Journal Title
 International Journal of Cardiology 
Issue Date
Angiotensin converting enzyme inhibitor ; Angiotensin receptor blocker ; Heart failure with reduced ejection fraction
BACKGROUND: After introduction of up-titration strategy, there are limited data on comparison between the effects of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB) in patients with heart failure with reduced ejection fraction (HFrEF). The study sought to investigate the association between treatment with ARB at discharge and clinical outcomes in patients with HFrEF compared with treatment with ACEI or no renin angiotensin system blocker (RASB). METHODS: The KorAHF registry is a prospective multicenter cohort and included patients who were hospitalized for acute heart failure (AHF). We studied 3005 patients with HFrEF (<40%), and divided into ARB (n=1190), ACEI (n=1090), and no RASB (n=725) groups. Propensity score matching was performed. RESULTS: All-cause death occurred in 346 patients (29.1%) in the ARB group, 315 patients (28.9%) in the ACEI group, and 305 (42.1%) in the no RASB group. After propensity score matching (ARB vs. ACEI, 827 pairs), there was no significant difference between the two groups in the rate of death (HR 0.91, 95% CI 0.76-1.09, p=0.32). All-cause death was significantly lower in the ARB group than in the no RASB group (ARB vs. no RASB, 538 pairs, HR 0.69, 95% CI 0.56-0.83, p<0.001). The ARB group had a significantly lower discontinuation rate than the ACEI group (20.8% vs. 33.6%, p<0.001). CONCLUSIONS: For treatment of AHF with reduced EF after hospitalization, ARB at discharge shows a mortality benefit comparable to that of ACEI. In addition, tolerability of medication was greater for ARB than for ACEI.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
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