Renin-Angiotensin System Inhibition and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries with Heart Failure.
Heart failure is the leading cause for 30-day all-cause readmission, the reduction of which is a goal of the Affordable Care Act. There is a growing interest in understanding the impact of evidence-based heart failure therapy on 30-day all-cause readmission. In the current study, we examined the impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI-ARBs) on 30-day all-cause readmission in heart failure.



Of the 1384 hospitalized Medicare beneficiaries with heart failure and left ventricular ejection fraction <45% discharged alive from 106 Alabama hospitals (1998-2001) without prior ACEI-ARB use and without known contraindications to ACEI-ARB use; 734 received new predischarge prescriptions for these drugs. Using propensity scores for ACEI-ARB initiation, we assembled a matched cohort of 477 pairs of patients balanced on 32 baseline characteristics (mean age 75 years, 46% women, 26% African American).



Thirty-day all-cause readmissions occurred in 18% and 24% of matched patients receiving and not receiving ACEI-ARBs, respectively (hazard ratio [HR] 0.74; 95% confidence interval [CI], 0.56-0.97; P = .030). ACEI-ARB use was also associated with lower risk of 30-day all-cause mortality (HR 0.56; 95% CI, 0.33-0.98; P = .041) and of the combined endpoint of 30-day all-cause readmission or 30-day all-cause mortality (HR 0.73; 95% CI, 0.56-0.94; P = .017). All associations remained significant at 1 year post discharge.



Among hospitalized patients with heart failure and reduced ejection fraction, the use of ACEI-ARBs was associated with a significantly lower risk of 30-day all-cause readmission and 30-day all-cause mortality; both beneficial associations persisted during long-term follow-up.
St John Providence Health System, Southfield, Mich.
Kumar
K
Sanam
University of Alabama at Birmingham, Ala.
Vikas
V
Bhatia
University of Alabama at Birmingham, Ala.
Navkaranbir S
NS
Bajaj
University of Alabama at Birmingham, Ala.
Saurabh
S
Gaba
University of Alabama at Birmingham, Ala.
Charity J
CJ
Morgan
University of California, Los Angeles.
Gregg C
GC
Fonarow
Stony Brook University, NY.
Javed
J
Butler
University of California, San Francisco, Fresno.
Prakash
P
Deedwania
University of Alabama at Birmingham, Ala; Veterans Affairs Medical Center, Birmingham, Ala.
Sumanth D
SD
Prabhu
Veterans Affairs Medical Center, Providence, RI.
Wen-Chih
WC
Wu
Montreal Heart Institute, Que., Canada.
Michel
M
White
Case Western Reserve University, Cleveland, Ohio.
Thomas E
TE
Love
New York Medical College, Valhalla.
Wilbert S
WS
Aronow
Veterans Affairs Medical Center, Washington, DC.
Ross D
RD
Fletcher
Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC.
Richard M
RM
Allman
Veterans Affairs Medical Center, Washington, DC. Electronic address: aliahmedmdmph@gmail.com.
Ali
A
Ahmed
D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009026:Mortality; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D065840:Protective Factors; D012084:Renin-Angiotensin System; D013318:Stroke Volume; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy*
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
ACEI or ARB; Heart failure; Hospital readmission