Impact of left ventricular ejection fraction on the effect of renin-angiotensin system blockers after an episode of acute heart failure: From the KCHF Registry

Abstract

Objective This observational study aimed to examine the prognostic association of angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARB) in different left ventricular ejection fraction (LVEF) categories. Methods In 3717 patients enrolled in the KCHF Registry, a multicentre registry including consecutive patients hospitalized for acute heart failure (HF), we assessed patient characteristics and association between ACE-I/ARB and clinical outcomes according to LVEF. In the three LVEF categories (reduced LVEF [HFrEF], mid-range LVEF [HFmrEF] and preserved LVEF [HFpEF]), we compared the patients with ACE-I/ARB as discharge medication and those without, and assessed their 1-year clinical outcomes. We defined the primary outcome measure as a composite of all-cause death and HF hospitalization. Results The 1-year cumulative incidences of the primary outcome measure were 36.3% in HFrEF, 30.1% in HFmrEF and 33.8% in HFpEF (log-rank P = 0.07). The adjusted risks of the ACE-I/ARB group relative to the no ACE-I/ARB group for the primary outcome measure were significantly lower in HFrEF and HFmrEF (HR 0.66 [95%CI 0.54–0.79], P<0.001, and HR 0.61 [0.45–0.82], P = 0.001, respectively), but not in HFpEF (HR 0.95 [0.80–1.14], P = 0.61). There was a significant interaction between the LVEF category and the ACE-I/ARB use on the primary outcome measure (P interaction = 0.01). Conclusions ACE-I/ARB for patients who were hospitalized for acute HF was associated with significantly lower risk for a composite of all-cause death and HF hospitalization in HFrEF and HFmrEF, but not in HFpEF. ACE-I/ARB might be a potential treatment option in HFmrEF as in HFrEF.

Characterization and selection of Japanese electronic health record databases used as data sources for non-interventional observational studies

“…Such studies are usually conducted prospectively, although the disease registries or databases themselves are sometimes used for retrospective secondary analysis. In the identified studies, three Japanese registries/databases were used by researchers of different studies: All-Japan Utstein Registry [ 22 , 23 ], National Database of Rheumatic Diseases by iR-net (Division of Rheumatology, Immunologic Disorder Network, National Hospital Organization) in Japan (NinJa) [ 24 , 25 ], and Kyoto Congestive Heart Failure (KCHF) Registry [ 26 , 27 ]. In addition, although our focus was on studies conducted in Japan, we identified seven registry studies conducted by using the Surveillance, Epidemiology, and End Results (SEER) program of the US National Cancer Institute.…”

Characterization and selection of Japanese electronic health record databases used as data sources for non-interventional observational studies

“…Such studies are usually conducted prospectively, although the disease registries or databases themselves are sometimes used for retrospective secondary analysis. In the identi ed studies, three Japanese registries/databases were used by researchers of different studies: All-Japan Utstein Registry 16,17 , National Database of Rheumatic Diseases in Japan (NinJa) 18,19 , and Kyoto Congestive Heart Failure (KCHF) Registry 20,21 . In addition, although our focus was on studies conducted in Japan, we identi ed seven registry studies conducted by using the Surveillance, Epidemiology, and End Results (SEER) program of the US National Cancer Institute.…”