Comparative effectiveness of different angiotensin-converting enzyme inhibitors on the risk of hospitalization in patients with heart failure.
OBJECTIVE
Existing randomized controlled trials do not address the comparative effectiveness of different angiotensin-converting enzyme inhibitors (ACEIs) on hospitalization due to heart failure (HF)-hospitalization in patients with HF. We sought to examine the effect of four ACEIs on HF-hospitalization in a large real-world HF population.


METHODS
The study was a retrospective analysis of a national cohort of patients with HF identified from the Department of Veterans Affairs (TX, USA). A multiple propensity score analysis was used to balance 47 baseline patient characteristics between the different ACEIs. The effect of different ACEIs on time to HF-hospitalization was assessed using the multiple propensity score-weighted multivariable Cox proportional hazard model.


RESULTS
The study included 139,994 patients with 69.50% (97,293) on lisinopril, 21.79% (30,503) on fosinopril, 8.41% (11,775) on captopril and 0.30% (423) on enalapril. Propensity scores balanced nearly all differences between different ACEIs groups. Enalapril (hazard ratio [HR]: 0.800; 95% CI: 0.492-1.297), fosinopril (HR: 0.971; 95% CI: 0.877-1.074), and lisinopril (HR: 1.005; 95% CI: 0.918-1.101) when compared with captopril were found to have similar effectiveness in reducing HF-hospitalizations.


CONCLUSIONS
In patients with HF, we found that the four ACEIs are equally effective in reducing HF-hospitalization in day-to-day practice.
Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, 1441 Moursund Street, Houston, TX, USA.
Abhishek S
AS
Chitnis
Rajender R
RR
Aparasu
Hua
H
Chen
Michael L
ML
Johnson
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research / Q000379:methods; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D055118:Medication Adherence; D057216:Propensity Score; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors