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Angiotensin II receptor blockers for the treatment of heart failure: a class effect?
Marie Hudson1, Karin Humphries, Jack V Tu
1Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec. marie.hudson@mcgill.ca
Insights
Elderly heart failure patients prescribed losartan had worse survival rates than those on other angiotensin II receptor blockers (ARBs). This suggests ARBs do not have a universal class effect due to distinct drug properties.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Heart failure (HF) affects millions of elderly individuals globally.
- Angiotensin II receptor blockers (ARBs) are commonly prescribed for HF management.
- Understanding the class effect of ARBs on mortality in older adults is crucial for clinical practice.
Purpose of the Study:
- To investigate the class effect of angiotensin II receptor blockers (ARBs) on all-cause mortality.
- To compare the survival rates of elderly patients (≥65 years) with heart failure (HF) based on the specific ARB prescribed.
Main Methods:
- A retrospective, population-based study utilizing administrative healthcare data from Canadian provinces.
- Included 6876 elderly patients (mean age 78 years) discharged with heart failure and prescribed an ARB within 90 days.
- Compared mortality rates between patients receiving different ARBs, adjusting for various demographic, clinical, and treatment factors.
Main Results:
- Losartan was the most frequently prescribed ARB (61%).
- Irbesartan, valsartan, and candesartan were associated with significantly better survival rates compared to losartan (HRs 0.65-0.71).
- Telmisartan showed no significant difference in mortality compared to losartan (HR 0.92).
Conclusions:
- Elderly heart failure patients prescribed losartan experienced worse survival outcomes than those on other ARBs.
- The findings indicate a lack of a class effect for ARBs in this population.
- Pharmacologic variations among ARBs likely contribute to the observed differences in survival.
Study Objective:
To examine the class effect of angiotensin II receptor blockers (ARBs) on mortality in patients with heart failure who were aged 65 years or older.
Design:
Retrospective population-based study.
Data Source:
Administrative database that stores information on hospital discharge summaries for the Canadian provinces of Quebec, Ontario, and British Columbia.
Patients:
A total of 6876 patients aged 65 years or older who were discharged with a primary diagnosis of heart failure between January 1, 1998, and March 31, 2003, and who filled at least one prescription for an ARB within 90 days of discharge.
Measurements And Main Results:
Times to all-cause death in patients receiving individual ARBs were compared. Models were adjusted for demographic, clinical, physician, and hospital characteristics; models were also adjusted for dosage categories, which were represented by time-dependent variables. The cohort of 6876 patients had a mean +/- SD age of 78 +/- 7 years, and most (62%) were women. Losartan was the most frequently prescribed ARB (61%), followed by irbesartan (14%), valsartan (13%), candesartan (10%), and telmisartan (2%). Irbesartan, valsartan, and candesartan were associated with better survival rates than losartan (adjusted hazard ratios [HRs] and 95% confidence intervals [CIs] 0.65 [0.53-0.79], 0.63 [0.51-0.79], and 0.71 [0.57-0.90], respectively). No difference was noted in mortality in patients prescribed telmisartan compared with those receiving losartan (HR 0.92 [95% CI 0.55-1.54]).
Conclusions:
Elderly patients with heart failure who were prescribed losartan had worse survival rates compared with those prescribed other commonly used ARBs. The absence of a class effect for ARBs is consistent with data showing pharmacologic differences among the drugs.
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