Angiotensin converting enzyme inhibitors and angiotensin receptor blockers in acute heart failure: invasive hemodynamic parameters and clinical outcomes

There are limited data regarding the use of angiotensin convert-ing enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) in acute heart failure (AHF). The purpose is to determine the patterns of ACEi/ARB use at the time of admission and discharge in relation to in-vasive hemodynamic data, mortality, and heart failure (HF) readmis-sions. This isa retrospective single-center study in patients with AHF who underwent right heart catheterization between January 2010 and December 2016. Patients on dialysis, evidence of shock, or in-complete follow up were excluded. Multivariate logistic regression analysis was used to analyze the factors associated with continua-tion of ACEi/ARB use on discharge and its relation to mortality and HF readmissions. The final sample was 626 patients. Patients on ACEi/ARB on admission were most likely continued on discharge. The most common reasons for stopping ACEi/ARB were worsening re -nal function (WRF), hypotension, and hyperkalemia. Patients with ACEi/ARB use on admission had a significantly higher systemic vascu-lar resistance (SVR) and mean arterial pressure (MAP), but lower car-diac index (CI). Patients with RA pressures above the median received less ACEi/ARB (P= 0.025) and had significantly higher inpatient mor-tality (P= 0.048). A?ter multivariate logistic regression, ACEi/ARB use at admission was associated with less inpatient mortality; OR 0.32 95% CI (0.11 to 0.93), and this e?fect extended to the subgroup of patients with HFpEF. Patients discharged on ACEi/ARB had signifi-cantly less 6-month HF readmissions OR 0.69 95% CI (0.48 to 0.98). ACEi/ARB use on admission for AHF was associated with less inpa-tient mortality including in those with HFpEF.