Renin-Angiotensin System Inhibitors Prognostic Benefit in Older Patients with Atrial Fibrillation
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Published on: May 26, 2022
María Cespón-Fernández1, Sergio Raposeiras-Roubín2, Emad Abu-Assi2
1Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain; PhD Program: Clinical Research in Medicine, University of Santiago de Compostela, Santiago, Spain.
Insights
Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) did not improve survival or reduce major cardiovascular events in older patients with atrial fibrillation (AF). Further research is needed in this specific population.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) are used for atrial fibrillation (AF) upstream therapy.
- Their prognostic value in older AF patients regarding mortality and cardiovascular events remains unclear.
- Existing evidence in this demographic is limited and contradictory.
Purpose of the Study:
- To evaluate the benefits of ACEi and ARB on mortality and major cardiovascular outcomes in elderly patients with AF.
- To analyze real-world data for insights into the effectiveness of these drug classes in a specific older population.
Main Methods:
- Retrospective analysis of the CardioCHUVI-AF_75 registry (NCT04364516).
- Included 9365 patients aged 75 years or older with AF.
- Propensity score matching created comparable groups (3601 patients each) with and without ACEi/ARB treatment, analyzed using Cox proportional hazards models.
Main Results:
- No significant difference in survival was found between patients using ACEi/ARB and those not (HR: 0.959, 95% CI: 0.872-1.054).
- No significant differences in major cardiovascular events (heart failure hospitalization, myocardial infarction, stroke) were observed between the groups.
Conclusions:
- ACEi and ARB treatment did not demonstrate improved survival or reduced cardiovascular events in older AF patients.
- These findings highlight the need for dedicated randomized clinical trials in the elderly AF population to clarify treatment benefits.
Objectives:
Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) have shown antiarrhythmic effects that are useful as part of the upstream therapy for atrial fibrillation (AF), both for primary and secondary prevention. Nevertheless, the potential prognosis value of these drugs in terms of mortality and major cardiovascular events is unclear, especially in older population with AF. Scientific evidence is scarce in this population and shows contradictory results. The aim of this study was to assess the potential benefit of ACEi and ARB in terms of mortality and major cardiovascular outcomes (hospitalization for heart failure, acute myocardial infarction and stroke) in older patients with AF, based on a real-world data analysis.
Design:
Observational: analysis of a retrospective registry.
Settings And Participants:
The study included 9365 patients of 75 years or older diagnosed with AF, from CardioCHUVI-AF_75 registry: ClinicalTrials.gov Identifier: NCT04364516. Date of registration: November 26, 2018.
Methods:
We performed propensity score matching techniques to obtain 2 comparable groups of 3601 patients with and without ACEi or ARB treatment. We compared survival and cardiovascular outcomes in both groups of patients using Cox proportional hazards models.
Results:
We did not find significant differences in terms of survival between using or not using ACEi or ARB for the older population (hazard ratio for mortality: 0.959, 95% confidence interval 0.872-1.054). There were no significant differences regarding cardiovascular major events between the 2 groups.
Conclusions And Implications:
Treatment with ACEi or ARB did not improve outcomes in terms of survival and cardiovascular events in older patients with AF. These results should prompt the conduct of randomized clinical trials specifically in the older AF patient population to robustly address this issue.
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