Efficacy and safety of apixaban versus warfarin in LVAD patients: A propensity-matched analysis.

OBJECTIVE

Aim: To compare 5-year cognitive outcomes in patients with HFrEF who receive angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).

PATIENTS AND

METHODS

Materials and

Methods

Retrospective cohort study of: 1) 135,873 adults with HFrEF (International Classification of Diseases-10th Revision-Clinical Modification [ICD-10-CM] codes: I50.2 or I50.4) started on ACEI between Aug 1, 2019 and Aug 1, 2024; and 2) 135,873 propensity matched patients receiving ARBs during that time. Data were obtained from the TriNetX Research Network, encompassing 80 health care organizations in the United States. The primary endpoint was the composite of cognitive decline (ICD-10-CM: R41.8), dementia (ICD-10-CM: F01-F03), and Alzheimer's disease (ICD-10- CM: G30).

RESULTS

Results

At 5 years,17,679 patients on ACEI met the primary endpoint vs 16,345 patients on ARBs (5-year incidence: 30.71% vs 28.54%; HR: 1.153; 95% CI: 129-1.178; P < 0.001), with consistently higher rates of cognitive decline (24.94% vs 22.81%; HR: 1.146; 95% CI: 1.119-1.174; P < 0.001), dementia (15.63% vs 13.71%; HR:1.204; 95% CI: 1.168-1.241; P < 0.001), and Alzheimer's disease (4.15% vs 3.51%; HR: 1.202; 95% CI: 1.131-1.277; P < 0.001) in the ACEI cohort.

CONCLUSION

Conclusions

ACEI was associated with higher 5-year rates of neurocognitive disorders when compared to ARBs in patients with HFrEF.