Related Experiment Video

Updated: Oct 18, 2025

Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
05:16

Cutoff 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

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Patterns of Use and Clinical Outcomes with Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers

Roy O Mathew1, Kevin Bryan Lo2, Padmavathi Tipparaju3

  • 1Division of Nephrology, Columbia VA Health Care System, Columbia, South Carolina, USA.

Cardiorenal Medicine
|October 3, 2021
PubMed

Insights

Higher serum creatinine in acute heart failure patients predicts withholding of ACEI/ARBs. Discharging patients on ACEI/ARBs significantly reduces mortality risk.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Acute heart failure (AHF) management involves optimizing guideline-directed medical therapy.
  • Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) are crucial for heart failure treatment.
  • Kidney function is a key consideration in medication management for AHF patients.

Purpose of the Study:

  • To investigate patterns and predictors of ACEI/ARB utilization in AHF.
  • To examine the impact of kidney function changes on ACEI/ARB use during hospitalization.
  • To correlate ACEI/ARB use with clinical outcomes in AHF.

Main Methods:

  • Retrospective analysis of Veterans' Health Administration data (2016).
  • Inclusion of hospitalized patients with heart failure with reduced ejection fraction.
  • Exclusion of patients with estimated glomerular filtration <15 cm3/min/1.73 m2 or on dialysis.
  • Categorization of patients based on ACEI/ARB therapy: continued, initiated, discontinued, or none.
  • Multivariable logistic and Cox regression analyses to identify predictors and evaluate outcomes (mortality, readmissions).

Main Results:

  • 37% of AHF patients had ACEI/ARB discontinued or not initiated.
  • Increased admission serum creatinine (SCr) was independently associated with lower ACEI/ARB continuation/initiation (OR 0.51, 95% CI 0.46-0.57).
  • Discharge on ACEI/ARB was linked to significantly lower 30-day (HR 0.36) and 180-day mortality (HR 0.23).

Conclusions:

  • Admission SCr is a critical factor influencing ACEI/ARB withholding in AHF.
  • Discharge ACEI/ARB therapy is associated with improved survival in AHF patients.
  • Optimizing ACEI/ARB use in AHF, even with impaired kidney function, may improve outcomes.
Abstract

Keywords:
Acute heart failureAngiotensin receptor blockersAngiotensin-converting enzyme inhibitorsMortalityOutcomesReadmissions

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