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Impact of Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptors Blockers on Mortality in Acute Heart Failure Patients with Left Ventricular Systolic Dysfunction in the Middle East: Observations from the Gulf Acute Heart Failure Registry (Gulf CARE)

[ Vol. 16 , Issue. 6 ]

Author(s):

Ibrahim Al-Zakwani*, Kadhim Sulaiman, Jawad A. Al-Lawati, Alawi A. Alsheikh-Ali, Prashanth Panduranga, Khalid F. Al-Habib, Jassim Al Suwaidi, Wael Al-Mahmeed, Hussam Al-Faleh, Abdelfatah Elasfar, Ahmed Al-Motarreb, Mustafa Ridha, Bassam Bulbanat, Mohammed Al-Jarallah, Nooshin Bazargani, Nidal Asaad and Haitham Amin   Pages 596 - 602 ( 7 )

Abstract:


Aims: To evaluate the impact of Angiotensin-Converting Enzyme Inhibitors (ACEIs)/ Angiotensin Receptors Blockers (ARBs) on in-hospital, 3- and 12-month all-cause mortality in Acute Heart Failure (AHF) patients with left ventricular systolic dysfunction in 7 countries of the Middle East.

Methods and Results: Data was analysed from 2,683 consecutive patients admitted with AHF and Left Ventricular Ejection Fraction (LVEF) (<40%) from 47 hospitals from February to November 2012. Analyses were evaluated using univariate and multivariate statistics. The overall mean age of the cohort was 58±15, 72% (n=1,937) were males, 62% (n=1,651) had coronary artery disease, 57% (n=1,539) were hypertensives and 47% (n=1,268) had diabetes. Overall cumulative mortality at inhospital, 3- and 12-month follow-up was 5.8% (n=155), 12.6% (n=338) and 20.4% (n=548), respectively. Adjusting for demographic and clinical characteristics as well as medication in a multivariate logistic regression model, ACEIs were associated with lower risk of in-hospital mortality (adjusted odds ratio (aOR), 0.48; 95% Confidence Interval (CI): 0.25 to 0.94; p=0.031). At 3-month follow-up, both ACEIs (aOR, 0.64; 95% CI: 0.43 to 0.95; p=0.025) and ARBs (aOR, 0.34; 95% CI: 0.18 to 0.62; p<0.001) were associated with lower risk of mortality. Additionally, at 12-month follow-up, those prescribed ACEIs (aOR, 0.71; 95% CI: 0.53 to 0.96; p=0.027) and ARBs (aOR, 0.47; 95% CI: 0.31 to 0.71; p<0.001) were still associated with lower risk of mortality.

Conclusion: ACEIs and ARBs treatments were associated with lower mortality risk during admission and up to 12-month of follow-up in Middle East AHF patients with left ventricular systolic dysfunction.

Keywords:

Heart failure, ejection fraction, angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, mortality, Middle East.

Affiliation:

Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University and Gulf Health Research, Muscat, Department of Cardiology, Royal Hospital, and Director General of Specialized Medical Care, Ministry of Health, Muscat, Directorate General of Primary Health Care, Ministry of Health, Muscat, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, Department of Cardiology, Royal Hospital, Muscat, Department of Cardiac Sciences, King Fahad Cardiac Centre, King Saud University, Riyadh, Department of Adult Cardiology, Hamad Medical Corporation and Qatar Cardiovascular Research Centre, Doha, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, Department of Cardiac Sciences, King Fahad Cardiac Centre, King Saud University, Riyadh, Department of Adult Cardiology, King Salman Heart Centre, King Fahad Medical City, Riyadh, Saudi Arabia, and Cardiology Department, Tanta University, Tanta, Department of Internal Medicine, Faculty of Medicine, Sana`a University, Sana`a, Division of Cardiology, Al-Dabous Cardiac Centre, Al Adan Hospital, Kuwait City, Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Kuwait City, Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Kuwait City, Department of Cardiology, Dubai Hospital, Dubai, Department of Adult Cardiology, Hamad Medical Corporation and Qatar Cardiovascular Research Centre, Doha, Mohammed Bin Khalifa Cardiac Centre, Manama

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