Lower Risk of Death and Kidney Failure Associated with Higher Target (vs Below-Target) Doses of RAS Inhibitors in...

Area of Science:

• Cardiology
• Nephrology
• Geriatrics

Background:

• Renin-angiotensin system (RAS) inhibitors at higher doses are known to reduce mortality in heart failure with reduced ejection fraction (HFrEF).
• Effectiveness of target-dose RAS inhibitors in octogenarians with HFrEF is less understood.
• This study aimed to investigate RAS inhibitor effectiveness in elderly HFrEF patients.

Purpose of the Study:

• To evaluate the impact of target-dose RAS inhibitors on mortality and kidney failure in octogenarians with HFrEF.
• To compare outcomes between patients receiving target-dose versus below-target dose RAS inhibitors.

Main Methods:

• A cohort of 32,964 veterans aged 80 years or older with HFrEF was analyzed.
• Propensity scores were used to create a matched cohort of 13,284 patients.
• 5-year mortality and kidney failure risks associated with target-dose RAS inhibitors were estimated.

Main Results:

• Target-dose RAS inhibitor use was associated with a significant reduction in all-cause mortality (HR, 0.95; P = .009).
• A trend towards lower kidney failure risk was observed with target-dose RAS inhibitors (HR, 0.80; P = .094).
• The composite endpoint of kidney failure or death was significantly lower in the target-dose group (HR, 0.94; P = .004).

Conclusions:

• Higher target doses of RAS inhibitors are associated with reduced mortality in octogenarians with HFrEF.
• These findings suggest potential benefits for kidney function as well, with a trend towards lower kidney failure risk.
• The study provides evidence supporting the use of higher-dose RAS inhibitors in elderly HFrEF patients.