Heart failureA Propensity-Matched Study of the Comparative Effectiveness of Angiotensin Receptor Blockers Versus Angiotensin-Converting Enzyme Inhibitors in Heart Failure Patients Age ≥65 Years
Section snippets
Methods
The present study was based on the Alabama Heart Failure Project registry, which has been previously described.6 Briefly, the Alabama Heart Failure Project was conducted by AQAF, Alabama's quality improvement organization, as a quality improvement project. Extensive data on baseline demographics, medical history including the use of medications, hospital course, discharge disposition including medications, and physician specialty were collected via chart abstraction from 8,555 patients
Results
Overall, matched patients (n = 1,310) had a mean age of 78 ± 7 years, 69% were women, and 19% were African American. Imbalances in baseline characteristics before matching and balances achieved after matching between patients prescribed ACE inhibitors and ARBs at discharge are listed in Table 1 and shown in Figure 1. Before matching, patients prescribed ARBs were more likely to be women and had a higher prevalence of hypertension and coronary revascularization, a lower prevalence of atrial
Discussion
The findings of the present propensity-matched comparative effectiveness research demonstrate that older HF patients discharged with prescriptions of ARBs (vs ACE inhibitors) had lower all-cause mortality. This association was independent of 56 baseline demographic, clinical, subclinical, and biochemical characteristics and was driven primarily by a greater mortality reduction in those with HF-PEF. Although ARB use had no significant association with hospitalizations overall, there was a trend
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Dr. Ahmed is supported by grants R01-HL085561 and R01-HL097047 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and a generous gift from Ms. Jean B. Morris, Birmingham, Alabama. Dr. Allman was supported in part by the NIH grant award 1UL 1RR025777.