title: Prognostic impact of angiotensin-converting enzyme inhibitor therapy in diastolic heart failure.
abstract: The angiotensin-converting enzyme (ACE) inhibitor has a well defined place in the treatment of systolic heart failure (HF). Evidence for routine prescription of an ACE inhibitor in patients with diastolic HF (DHF) is inconsistent. Therefore, our aim was to evaluate the prognostic impact of ACE inhibitor in patients with DHF. The present prospective study included patients with normal or slightly impaired ejection fraction (> or =50%) surviving a first hospitalization for HF. We assessed the long-term prognosis of these patients according to prescription of an ACE inhibitor at discharge. ACE inhibitor therapy prescribed at discharge in 46% (n = 165) of the 358 included patients was associated with a 30% relative decrease in the risk of 5-year mortality (hazard ratio 0.70, 95% confidence interval 0.53 to 0.93, p = 0.013). On multivariable Cox analysis, the relation between ACE inhibitor prescription and mortality remained significant (hazard ratio 0.73, 95% confidence interval 0.54 to 0.99, p = 0.045). Using propensity score analysis, 120 patients receiving an ACE inhibitor were matched with 120 patients not receiving this medication. In the postmatch group, prescription of ACE inhibitor was associated with a significant decrease in the risk of 5-year mortality (hazard ratio 0.61, 95% confidence interval 0.43 to 0.87, p = 0.006). Five-year relative survival (observed/expected survival) of the ACE inhibitor group was better than that of the no-ACE inhibitor group (65% vs 57%). In conclusion, we demonstrate that in this cohort of patients with DHF, prescription of ACE inhibitor was associated with a significant decrease in long-term mortality.
authors.affiliation: INSERM, ERI 12 and University Hospital Amiens, Amiens, France. tribouilloy.christophe@chu-amiens.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.forename: Dan
authors.initials: D
authors.lastname: Rusinaru
authors.forename: Laurent
authors.initials: L
authors.lastname: Leborgne
authors.forename: Marcel
authors.initials: M
authors.lastname: Peltier
authors.forename: Ziad
authors.initials: Z
authors.lastname: Massy
authors.forename: Michel
authors.initials: M
authors.lastname: Slama
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D054144:Heart Failure, Diastolic / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors