Abstract：
OBJECTIVE: Limited data are available that evaluate the efficacy of renin-angiotensin system inhibitor (RASI) dose-reduction in older adults with heart failure with reduced ejection fraction following a heart failure hospitalization.
RESULTS: We examined a 5% random sample of Medicare beneficiaries with prescription coverage who were discharged to home following a hospitalization for heart failure with reduced ejection fraction between 1 January 2007 and 30 June 2018 and were treated with RASI prior to hospitalization. We classified patients into three mutually exclusive groups based on RASI dosage before (prescription fills up to 90 days prior to) and after a hospitalization (prescription fills up to 365 days that were most proximate to the discharge date as possible)-same/increased dose, dose-reduction, and discontinuation. We examined associations between RASI prescribing patterns and outcomes (mortality and all-cause readmission at 30 days and 1 year) using Cox proportional hazards models. Among 12 794 unique older adults, 36.8% experienced a RASI reduction following their hospitalization for HFrEF-15.7% had a dose-reduction and 21.1% had a discontinuation. Neither dose-reduction nor discontinuation was associated with 30-day mortality. Discontinuation was associated 1-year mortality, 30-day all-cause readmission, and 1-year all-cause readmission, whereas dose-reduction was not.
CONCLUSIONS: RASI dose-reduction occurs in 1 out of 7 HF hospitalizations. In contrast to RASI discontinuation, RASI dose-reduction was not associated with adverse short or long-term outcomes. These findings indicate that RASI dose-reduction is preferred over RASI discontinuation in selected situations where RASI reduction is needed.
RESULTS: We examined a 5% random sample of Medicare beneficiaries with prescription coverage who were discharged to home following a hospitalization for heart failure with reduced ejection fraction between 1 January 2007 and 30 June 2018 and were treated with RASI prior to hospitalization. We classified patients into three mutually exclusive groups based on RASI dosage before (prescription fills up to 90 days prior to) and after a hospitalization (prescription fills up to 365 days that were most proximate to the discharge date as possible)-same/increased dose, dose-reduction, and discontinuation. We examined associations between RASI prescribing patterns and outcomes (mortality and all-cause readmission at 30 days and 1 year) using Cox proportional hazards models. Among 12 794 unique older adults, 36.8% experienced a RASI reduction following their hospitalization for HFrEF-15.7% had a dose-reduction and 21.1% had a discontinuation. Neither dose-reduction nor discontinuation was associated with 30-day mortality. Discontinuation was associated 1-year mortality, 30-day all-cause readmission, and 1-year all-cause readmission, whereas dose-reduction was not.
CONCLUSIONS: RASI dose-reduction occurs in 1 out of 7 HF hospitalizations. In contrast to RASI discontinuation, RASI dose-reduction was not associated with adverse short or long-term outcomes. These findings indicate that RASI dose-reduction is preferred over RASI discontinuation in selected situations where RASI reduction is needed.
摘要：
目的：现有有限的数据可用于评估肾素-血管紧张素系统抑制剂（RASI）剂量减少对老年心力衰竭患者住院后射血分数降低的疗效。
结果：我们对2007年1月1日至2018年6月30日期间因射血分数降低的心力衰竭住院后出院回家并在住院前接受RASI治疗的5%处方医疗保险受益人进行了随机抽样检查。我们根据住院前（处方填充前90天）和住院后（处方填充最多365天，最接近出院日期）将患者分为三个相互排斥的组-相同/增加剂量，剂量减少，和中止。我们使用Cox比例风险模型检查了RASI处方模式和结局（30天和1年时的死亡率和全因再入院）之间的关联。在12.794名独特的老年人中，36.8％的人因HFrEF-15.7％的人住院后出现RASI减少，21.1％的人停药。剂量减少或停药均与30天死亡率无关。停药与1年死亡率相关，30天全因重新接纳,和1年全因再入院，而剂量减少没有。
结论：RASI剂量减少发生在1/7的HF住院患者中。与RASI停药相反，RASI剂量减少与不良短期或长期结局无关。这些发现表明，在需要RASI减少的选定情况下，RASI剂量减少优于RASI停药。
结果：我们对2007年1月1日至2018年6月30日期间因射血分数降低的心力衰竭住院后出院回家并在住院前接受RASI治疗的5%处方医疗保险受益人进行了随机抽样检查。我们根据住院前（处方填充前90天）和住院后（处方填充最多365天，最接近出院日期）将患者分为三个相互排斥的组-相同/增加剂量，剂量减少，和中止。我们使用Cox比例风险模型检查了RASI处方模式和结局（30天和1年时的死亡率和全因再入院）之间的关联。在12.794名独特的老年人中，36.8％的人因HFrEF-15.7％的人住院后出现RASI减少，21.1％的人停药。剂量减少或停药均与30天死亡率无关。停药与1年死亡率相关，30天全因重新接纳,和1年全因再入院，而剂量减少没有。
结论：RASI剂量减少发生在1/7的HF住院患者中。与RASI停药相反，RASI剂量减少与不良短期或长期结局无关。这些发现表明，在需要RASI减少的选定情况下，RASI剂量减少优于RASI停药。
