Related Experiment Video
Updated: Feb 3, 2026
Receptor Autoradiography Protocol for the Localized Visualization of Angiotensin II Receptors
Published on: June 7, 2016
Kidney Function, ACE-Inhibitor/Angiotensin Receptor Blocker Use, and Survival Following Hospitalization for Heart
Michael H Chiu1,2, Robert J H Miller1,2, Rebecca Barry3
1Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, AB, Canada.
Insights
Patients with heart failure (HF) and reduced kidney function were less likely to receive ACE inhibitors/angiotensin receptor blockers (ACE-I/ARB). These medications reduced mortality risk by 25% regardless of kidney function, indicating a need for further research.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB) are known to improve outcomes in heart failure (HF) with reduced left-ventricular (LV) systolic function.
- However, their use and benefits in patients with HF and co-existing kidney disease are less certain due to potential increases in serum creatinine.
Purpose of the Study:
- To investigate the association between estimated glomerular filtration rate (eGFR), patterns of ACE-I/ARB use, and 1-year survival after hospitalization for HF.
- To determine if eGFR influences the effectiveness of ACE-I/ARB in HF patients.
Main Methods:
- A retrospective cohort study involving 1404 patients hospitalized with HF across three centers in Southern Alberta, Canada.
- Utilized the Pharmaceutical Information Network of Alberta for medication prescription data and provincial vital statistics for survival data.
- Multivariable Cox proportional hazards models were employed to analyze the association between ACE-I/ARB use and mortality, with eGFR as a potential modifying factor.
Main Results:
- Patients with lower eGFR (< 45 mL/min/1.73 m²) exhibited significantly lower rates of ACE-I/ARB use post-hospitalization compared to those with higher eGFR.
- ACE-I/ARB use following discharge was associated with a 25% reduced risk of mortality (HR: 0.75, 95% CI: 0.61-0.92).
- This mortality benefit of ACE-I/ARB was observed independently of eGFR, with no significant interaction detected (P = 0.75).
Conclusions:
- Patients with HF and reduced eGFR at hospital discharge were less likely to be prescribed ACE-I/ARB.
- Despite lower utilization, ACE-I/ARB use was linked to decreased mortality in HF patients, irrespective of their kidney function.
- Further research is warranted to establish optimal strategies for the safe and effective use of ACE-I and ARB in HF patients with kidney disease.
Background:
Angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ACE-I/ARB) improve outcomes in patients with heart failure and reduced left-ventricular (LV) systolic function. However, these medications can cause a rise in serum creatinine and their benefits in patients with HF accompanied by kidney disease are less certain.
Objective:
To characterize associations between estimated glomerular filtration rate (eGFR), patterns of ACE-Is and ARBs use, and 1-year survival following hospitalization for heart failure (HF).
Design:
We formed a retrospective cohort study of patients admitted with HF and followed HF medication prescriptions using the pharmaceutical information network, stratified by discharge eGFR.
Setting:
Cardiology services in 3 centers in Southern Alberta, Canada.
Patients:
The study cohort included patients admitted to hospital with a clinical diagnosis of HF.
Measurements:
eGFR was determined from inpatient laboratory data prior to discharge. Outpatient prescription data prior to and following the index hospitalization was obtained using the Pharmaceutical Information Network of Alberta and survival was determined from provincial vital statistics.
Methods:
Characteristics of the HF cohort were obtained from the Admissions Module of the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. Multivariable Cox proportional hazards models were used to evaluate the association between time-varying ACE-I/ARB use, and mortality, and to test whether eGFR modified this association.
Results:
Totally, 1404 patients were included. Within the first 3 months following discharge, ACE-I/ARBs were used in 71%, 67%, 62%, and 52% for those with eGFR > 90, 45-89, 30-44, and < 30 mL/min/1.73 m2, respectively, with differences in use persisting after 1 year of follow-up. Patients with eGFR < 45 mL/min/1.73 m2 had significantly lower rates of ACE-I/ARB use following hospitalization. In adjusted models, ACE-I/ARB use following discharge was associated with 25% lower risk of mortality (Hazard Ratio [HR]: 0.75, 95% confidence interval [CI]: 0.61-0.92; P < 0.01), without evidence that this association differed by eGFR (P = 0.75).
Limitations:
LV function measurements were not available for the cohort. Due to the observation design of the study, treatment-selection bias may be present.
Conclusion:
Patients with HF and reduced eGFR at time of hospital discharge were less likely to receive ACE-I/ARB despite these medications being associated with lower mortality independent of eGFR. These findings demonstrate the need for further research on strategies for safe use of ACE-I and ARB in patients with HF and kidney disease.
More Related Videos
07:49Author Spotlight: Investigating HR-Dependent Cardiac Function in Mouse Models Through a Novel Atrial-Pacing Approach
Published on: July 21, 2023
05:16Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers
01:22Heart Failure Drugs: β-Blockers
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
01:29Heart Failure II: Pathophysiology
01:17Pathophysiology of Heart Failure