Lower Risk of Death and Kidney Failure Associated with Higher Target (vs. Below-Target) Doses of RAS Inhibitors in Octogenarians with HFrEF
Document Type
Article
Publication Date
11-16-2024
Publication Title
The American Journal of Medicine
Abstract
BACKGROUND: Renin-angiotensin system inhibitors (RASIs) at higher target doses reduce the risk of death in patients with heart failure with reduced ejection fraction (HFrEF). Less is known about their effectiveness in octogenarians, the examination of which was the objective of this study. METHODS: Of 32,964 Veterans ≥ 80 years with HFrEF (ejection fraction ≤ 40%) receiving RASIs, 6655 received target-dose. Using propensity scores for target-dose, calculated for each of 32,964 patients, we assembled a matched cohort of 13,284 patients balanced on 66 baseline characteristics. Hazard ratios (95% CI) for 5-year mortality and kidney failure associated with target (vs. below-target) dose RASI were estimated in the matched cohort. Kidney failure was defined as receipt of kidney replacement therapy or estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73m measured twice >30 days apart. RESULTS: Patients had mean(±SD) age 84.5(±3.4) years, EF 31.3(±8.2) %, and eGFR 58.5(±18.2) mL/min/1.73m. All-cause mortality occurred in 71.2% and 69.5% of matched patients in below-target and target dose RASI groups, respectively (HR associated with target-dose RASI, 0.95; 95% CI, 0.91-0.99; p=0.009). Respective rates for kidney failure were 1.8% and 1.5%, with a trend toward a lower risk in the target-dose group (HR, 0.80; 95% CI, 0.61-1.04; p=0.094). Consequently, there was a lower risk of the composite endpoint of kidney failure or death (HR, 0.94; 95% CI, 0.91-0.98; p=0.004). CONCLUSIONS: These findings provide evidence that in octogenarians with HFrEF, the use of RASIs in higher target (vs. below-target) doses was associated with lower risks of death and kidney failure.
PubMed ID
39551174
Recommended Citation
Sin, Mo-Kyung; Allman, Richard M.; Faselis, Charles; Aronow, Wilbert S.; Brown, Cynthia J.; Lam, Phillip H.; Wu, Wen-Chih; Zeng-Treitler, Qing; Patel, Samir S.; Raman, Venkatesh K.; Zhang, Sijian; Sheriff, Helen M.; Morgan, Charity J.; Heidenreich, Paul A.; Fonarow, Gregg C.; and Ahmed, Ali, "Lower Risk of Death and Kidney Failure Associated with Higher Target (vs. Below-Target) Doses of RAS Inhibitors in Octogenarians with HFrEF" (2024). School of Medicine Faculty Publications. 3264.
https://digitalscholar.lsuhsc.edu/som_facpubs/3264
10.1016/j.amjmed.2024.10.019