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Abstract：
OBJECTIVE: There is currently no consensus on the effect of treatment with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), on the prognosis of patients with heart failure and preserved ejection fraction (HFpEF). Therefore, we have analysed the relationship of commencing treatment with ACEIs or ARBs and the prognosis of patients with incident HFpEF.
METHODS: Retrospective study over 15 years on 3864 patients with HFpEF (GAMIC cohort). Main outcomes were mortality (all-cause and cardiovascular) and hospitalisations for HF. The independent relationship between CT-RASIs and the prognosis, stratifying patients for cardiovascular comorbidity after propensity score-matching was analysed.
RESULTS: During a median follow-up of 7.94 years, 2960 died (76.6%) and 3138 were hospitalised (81.2%). Therapy with RASIs was associated with a lower mortality, all-cause (RR [95% CI] for ACEIs: 0.76 [0.66-0.86], and RR for ARBs: 0.88 [0.80-0.96]; P < 0.001 in both cases), and cardiovascular (RR for ACEIs: 0.72 [0.66-0.78], and RR for ARBs: 0.87 [0.80-0.94]; P < 0.001), a lower hospitalisation rate (RR for ACEIs: 0.82 [0.74-0.90], and RR for ARBs: 0.90 [0.82-0.98]; P < 0.001), and a lower 30-day readmission rate (RR for ACEIs: 0.66 [0.60-0.73], and RR for ARBs: 0.86 [0.75-0.97]; P < 0.001), after adjustment for the propensity to take RASIs or other medications, comorbidities and other potential confounders. Results on the effect of ARBs are compromised by the small number of patients. Analyses of recurrent hospitalisations gave larger treatment benefits than time-to-first-event analyses.
CONCLUSIONS: In this propensity-matched study, commencing treatment with ACEIs is associated with an improved prognosis of patients newly diagnosed with incident HFpEF.
METHODS: Retrospective study over 15 years on 3864 patients with HFpEF (GAMIC cohort). Main outcomes were mortality (all-cause and cardiovascular) and hospitalisations for HF. The independent relationship between CT-RASIs and the prognosis, stratifying patients for cardiovascular comorbidity after propensity score-matching was analysed.
RESULTS: During a median follow-up of 7.94 years, 2960 died (76.6%) and 3138 were hospitalised (81.2%). Therapy with RASIs was associated with a lower mortality, all-cause (RR [95% CI] for ACEIs: 0.76 [0.66-0.86], and RR for ARBs: 0.88 [0.80-0.96]; P < 0.001 in both cases), and cardiovascular (RR for ACEIs: 0.72 [0.66-0.78], and RR for ARBs: 0.87 [0.80-0.94]; P < 0.001), a lower hospitalisation rate (RR for ACEIs: 0.82 [0.74-0.90], and RR for ARBs: 0.90 [0.82-0.98]; P < 0.001), and a lower 30-day readmission rate (RR for ACEIs: 0.66 [0.60-0.73], and RR for ARBs: 0.86 [0.75-0.97]; P < 0.001), after adjustment for the propensity to take RASIs or other medications, comorbidities and other potential confounders. Results on the effect of ARBs are compromised by the small number of patients. Analyses of recurrent hospitalisations gave larger treatment benefits than time-to-first-event analyses.
CONCLUSIONS: In this propensity-matched study, commencing treatment with ACEIs is associated with an improved prognosis of patients newly diagnosed with incident HFpEF.
摘要：
目的：目前对血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）的治疗效果尚无共识。对心力衰竭和射血分数保留（HFpEF）患者预后的影响。因此,我们分析了开始接受ACEI或ARBs治疗与发生HFpEF的患者预后的关系.
方法：对3864例HFpEF患者进行15年的回顾性研究（GAMIC队列）。主要结局是死亡率（全因和心血管疾病）和HF住院。CT-RASI与预后的独立关系,对倾向评分匹配后的心血管合并症患者进行分层分析.
结果：在7.94年的中位随访期间，2960例死亡（76.6%），3138例住院（81.2%）。RASI治疗与较低的死亡率相关，所有原因(ACEI的RR[95%CI]：0.76[0.66-0.86]，ARB的RR：0.88[0.80-0.96]；两种情况下P<0.001），和心血管(ACEI的RR：0.72[0.66-0.78]，ARB的RR：0.87[0.80-0.94]；P<0.001），较低的住院率（ACEI的RR：0.82[0.74-0.90]，ARB的RR：0.90[0.82-0.98]；P<0.001），和较低的30天再入院率(ACEI的RR：0.66[0.60-0.73]，ARB的RR：0.86[0.75-0.97]；P<0.001），在调整服用RASI或其他药物的倾向后，合并症和其他潜在的混杂因素。关于ARBs效果的结果受到少数患者的损害。与首次事件发生时间分析相比，对反复住院的分析提供了更大的治疗益处。
结论：在这项倾向匹配研究中，开始ACEI治疗与新诊断的HFpEF事件患者的预后改善相关.
方法：对3864例HFpEF患者进行15年的回顾性研究（GAMIC队列）。主要结局是死亡率（全因和心血管疾病）和HF住院。CT-RASI与预后的独立关系,对倾向评分匹配后的心血管合并症患者进行分层分析.
结果：在7.94年的中位随访期间，2960例死亡（76.6%），3138例住院（81.2%）。RASI治疗与较低的死亡率相关，所有原因(ACEI的RR[95%CI]：0.76[0.66-0.86]，ARB的RR：0.88[0.80-0.96]；两种情况下P<0.001），和心血管(ACEI的RR：0.72[0.66-0.78]，ARB的RR：0.87[0.80-0.94]；P<0.001），较低的住院率（ACEI的RR：0.82[0.74-0.90]，ARB的RR：0.90[0.82-0.98]；P<0.001），和较低的30天再入院率(ACEI的RR：0.66[0.60-0.73]，ARB的RR：0.86[0.75-0.97]；P<0.001），在调整服用RASI或其他药物的倾向后，合并症和其他潜在的混杂因素。关于ARBs效果的结果受到少数患者的损害。与首次事件发生时间分析相比，对反复住院的分析提供了更大的治疗益处。
结论：在这项倾向匹配研究中，开始ACEI治疗与新诊断的HFpEF事件患者的预后改善相关.
