Use of different types of angiotensin converting enzyme inhibitors and mortality in systolic heart failure

Henrik Svanström; Björn Pasternak; Mads Melbye; Anders Hviid

doi:10.1016/j.ijcard.2014.12.092

Use of different types of angiotensin converting enzyme inhibitors and mortality in systolic heart failure

Henrik Svanström, Björn Pasternak, Mads Melbye, Anders Hviid

Institut for Klinisk Medicin

9 Citationer (Scopus)

Abstract

BACKGROUND: Angiotensin converting enzyme-inhibitors (ACEIs) are the first-line treatment for patients with heart failure (HF) with reduced ejection fraction (EF). The benefit of ACEIs in HF is regarded as a class effect and different types of agents are used interchangeably. However, evidence on the comparable effectiveness of different ACEIs is scarce. We conducted a registry-based cohort study to assess all-cause mortality associated with the use of enalapril, perindopril, and trandolapril, as compared with ramipril, in patients with systolic HF.

METHODS: Patients with systolic HF (EF ≤40%), 2003-2012, were identified using the Danish HF Registry. New users of enalapril (n=1807), perindopril (n=1064), ramipril (n=3270), or trandolapril (n=1150), who started treatment within 60days of first-time hospital diagnosis of HF, were selected for inclusion. Subgroup analyses were conducted by sex, age, NYHA-level, EF, and ischemic heart disease. All analyses were adjusted for empirical risk scores for mortality.

RESULTS: During follow-up, 291 deaths were observed among users of enalapril (incidence rate per 100person-years [IR], 10.1), 212 among users of perindopril (IR, 10.5), 568 among users of ramipril (IR, 10.6), and 251 among users of trandolapril (IR, 12.1). No significant differences in all-cause mortality were observed with the use of enalapril (adjusted hazard ratio [aHR] 0.95, 95% CI 0.82-1.10), perindopril (aHR 1.07, 95% CI 0.92-1.26), or trandolapril (aHR 1.08, 95% CI 0.93-1.26), as compared with ramipril. No significant differences were observed in subgroup analyses.

CONCLUSIONS: These findings suggest equal effect of different types of ACEIs on mortality in systolic HF.

Originalsprog	Engelsk
Tidsskrift	International Journal of Cardiology
Vol/bind	182
Sider (fra-til)	90-6
Antal sider	7
ISSN	0167-5273
DOI	https://doi.org/10.1016/j.ijcard.2014.12.092
Status	Udgivet - 1 mar. 2015

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10.1016/j.ijcard.2014.12.092

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@article{c815b060ead841d493bacb042d4e76c2,

title = "Use of different types of angiotensin converting enzyme inhibitors and mortality in systolic heart failure",

abstract = "BACKGROUND: Angiotensin converting enzyme-inhibitors (ACEIs) are the first-line treatment for patients with heart failure (HF) with reduced ejection fraction (EF). The benefit of ACEIs in HF is regarded as a class effect and different types of agents are used interchangeably. However, evidence on the comparable effectiveness of different ACEIs is scarce. We conducted a registry-based cohort study to assess all-cause mortality associated with the use of enalapril, perindopril, and trandolapril, as compared with ramipril, in patients with systolic HF.METHODS: Patients with systolic HF (EF ≤40%), 2003-2012, were identified using the Danish HF Registry. New users of enalapril (n=1807), perindopril (n=1064), ramipril (n=3270), or trandolapril (n=1150), who started treatment within 60days of first-time hospital diagnosis of HF, were selected for inclusion. Subgroup analyses were conducted by sex, age, NYHA-level, EF, and ischemic heart disease. All analyses were adjusted for empirical risk scores for mortality.RESULTS: During follow-up, 291 deaths were observed among users of enalapril (incidence rate per 100person-years [IR], 10.1), 212 among users of perindopril (IR, 10.5), 568 among users of ramipril (IR, 10.6), and 251 among users of trandolapril (IR, 12.1). No significant differences in all-cause mortality were observed with the use of enalapril (adjusted hazard ratio [aHR] 0.95, 95% CI 0.82-1.10), perindopril (aHR 1.07, 95% CI 0.92-1.26), or trandolapril (aHR 1.08, 95% CI 0.93-1.26), as compared with ramipril. No significant differences were observed in subgroup analyses.CONCLUSIONS: These findings suggest equal effect of different types of ACEIs on mortality in systolic HF.",

keywords = "Aged, Angiotensin-Converting Enzyme Inhibitors, Cause of Death, Denmark, Female, Heart Failure, Systolic, Humans, Male, Prospective Studies, Registries, Survival Rate, Treatment Outcome",

author = "Henrik Svanstr{\"o}m and Bj{\"o}rn Pasternak and Mads Melbye and Anders Hviid",

year = "2015",

month = mar,

day = "1",

doi = "10.1016/j.ijcard.2014.12.092",

language = "English",

volume = "182",

pages = "90--6",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - Use of different types of angiotensin converting enzyme inhibitors and mortality in systolic heart failure

AU - Svanström, Henrik

AU - Pasternak, Björn

AU - Melbye, Mads

AU - Hviid, Anders

PY - 2015/3/1

Y1 - 2015/3/1

N2 - BACKGROUND: Angiotensin converting enzyme-inhibitors (ACEIs) are the first-line treatment for patients with heart failure (HF) with reduced ejection fraction (EF). The benefit of ACEIs in HF is regarded as a class effect and different types of agents are used interchangeably. However, evidence on the comparable effectiveness of different ACEIs is scarce. We conducted a registry-based cohort study to assess all-cause mortality associated with the use of enalapril, perindopril, and trandolapril, as compared with ramipril, in patients with systolic HF.METHODS: Patients with systolic HF (EF ≤40%), 2003-2012, were identified using the Danish HF Registry. New users of enalapril (n=1807), perindopril (n=1064), ramipril (n=3270), or trandolapril (n=1150), who started treatment within 60days of first-time hospital diagnosis of HF, were selected for inclusion. Subgroup analyses were conducted by sex, age, NYHA-level, EF, and ischemic heart disease. All analyses were adjusted for empirical risk scores for mortality.RESULTS: During follow-up, 291 deaths were observed among users of enalapril (incidence rate per 100person-years [IR], 10.1), 212 among users of perindopril (IR, 10.5), 568 among users of ramipril (IR, 10.6), and 251 among users of trandolapril (IR, 12.1). No significant differences in all-cause mortality were observed with the use of enalapril (adjusted hazard ratio [aHR] 0.95, 95% CI 0.82-1.10), perindopril (aHR 1.07, 95% CI 0.92-1.26), or trandolapril (aHR 1.08, 95% CI 0.93-1.26), as compared with ramipril. No significant differences were observed in subgroup analyses.CONCLUSIONS: These findings suggest equal effect of different types of ACEIs on mortality in systolic HF.

AB - BACKGROUND: Angiotensin converting enzyme-inhibitors (ACEIs) are the first-line treatment for patients with heart failure (HF) with reduced ejection fraction (EF). The benefit of ACEIs in HF is regarded as a class effect and different types of agents are used interchangeably. However, evidence on the comparable effectiveness of different ACEIs is scarce. We conducted a registry-based cohort study to assess all-cause mortality associated with the use of enalapril, perindopril, and trandolapril, as compared with ramipril, in patients with systolic HF.METHODS: Patients with systolic HF (EF ≤40%), 2003-2012, were identified using the Danish HF Registry. New users of enalapril (n=1807), perindopril (n=1064), ramipril (n=3270), or trandolapril (n=1150), who started treatment within 60days of first-time hospital diagnosis of HF, were selected for inclusion. Subgroup analyses were conducted by sex, age, NYHA-level, EF, and ischemic heart disease. All analyses were adjusted for empirical risk scores for mortality.RESULTS: During follow-up, 291 deaths were observed among users of enalapril (incidence rate per 100person-years [IR], 10.1), 212 among users of perindopril (IR, 10.5), 568 among users of ramipril (IR, 10.6), and 251 among users of trandolapril (IR, 12.1). No significant differences in all-cause mortality were observed with the use of enalapril (adjusted hazard ratio [aHR] 0.95, 95% CI 0.82-1.10), perindopril (aHR 1.07, 95% CI 0.92-1.26), or trandolapril (aHR 1.08, 95% CI 0.93-1.26), as compared with ramipril. No significant differences were observed in subgroup analyses.CONCLUSIONS: These findings suggest equal effect of different types of ACEIs on mortality in systolic HF.

KW - Aged

KW - Angiotensin-Converting Enzyme Inhibitors

KW - Cause of Death

KW - Denmark

KW - Female

KW - Heart Failure, Systolic

KW - Humans

KW - Male

KW - Prospective Studies

KW - Registries

KW - Survival Rate

KW - Treatment Outcome

U2 - 10.1016/j.ijcard.2014.12.092

DO - 10.1016/j.ijcard.2014.12.092

M3 - Journal article

C2 - 25576729

SN - 0167-5273

VL - 182

SP - 90

EP - 96

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Use of different types of angiotensin converting enzyme inhibitors and mortality in systolic heart failure

Abstract

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