Revista clinica espanola · 2026
Baseline treatment with beta-blockers and renin-angiotensin system inhibitors and their association with adverse events in acute heart failure.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Haro Antoni, Jacob Javier, Rossello Xavier, Alquezar-Arbe Aitor, Llorens Pere, Miró Òscar, en representación del grupo ICASEMES
Аннотация
INTRODUCTION: Baseline treatment with beta-blockers (BB) and/or renin-angiotensin system inhibitors (RASi) has been extensively studied in the context of heart failure, given its fundamental role in modulating the neurohormonal axis and improving survival.
OBJECTIVE: To investigate whether there is an association between receiving baseline treatment with BB or RASi, either alone or in combination, and the short-term prognosis of an episode of acute heart failure (AHF).
METHOD: Patients from the EAHFE registry (Epidemiology of Acute Heart Failure in Spanish Emergency Departments) were analyzed. This is a multicenter, prospective, multipurpose registry that collects all AHF episodes presenting to participating hospital emergency departments (EDs) over a period of 1-2 months between 2007 and 2018. The primary outcome variable investigated was in-hospital all-cause mortality during the ED stay or hospitalization. Adjusted analyses were conducted using multiple logistic regression and multiple imputation to control for potential confounding factors.
RESULTS: The study included a total of 17,916 episodes of acute heart failure (AHF). A total of 26.2% of patients did not receive treatment with either beta-blockers (BB) or renin-angiotensin system inhibitors (RASi), constituting the reference group. Overall, 17.8% of patients received BB only, 30.4% were treated exclusively with RASi, and 25.7% received a combination of both drugs. The mean age of the patients was 80.4 years (standard deviation 10.2 years), and 55.7% were women. In-hospital mortality was 7.3%. After multivariable adjustment, a significant association with lower mortality was found for treatment with BB alone (odds ratio [OR] = 0.826, 95% confidence interval [CI] 0.685-0.996), OR = 0.709 (CI95% 0.600-0.837) RASi alone and for combined treatment with RASi and BB (OR = 0.699, 95%CI 0.580-0.843). In the adjusted model with multiple imputation, the results remained significant.
CONCLUSIONS: In patients with an episode of AHF, baseline treatment with BB, RASi, or both is associated with lower all-cause mortality. This association is strongest in the group of patients receiving both treatments combined, and the results remain significant after multivariate adjustment.
OBJECTIVE: To investigate whether there is an association between receiving baseline treatment with BB or RASi, either alone or in combination, and the short-term prognosis of an episode of acute heart failure (AHF).
METHOD: Patients from the EAHFE registry (Epidemiology of Acute Heart Failure in Spanish Emergency Departments) were analyzed. This is a multicenter, prospective, multipurpose registry that collects all AHF episodes presenting to participating hospital emergency departments (EDs) over a period of 1-2 months between 2007 and 2018. The primary outcome variable investigated was in-hospital all-cause mortality during the ED stay or hospitalization. Adjusted analyses were conducted using multiple logistic regression and multiple imputation to control for potential confounding factors.
RESULTS: The study included a total of 17,916 episodes of acute heart failure (AHF). A total of 26.2% of patients did not receive treatment with either beta-blockers (BB) or renin-angiotensin system inhibitors (RASi), constituting the reference group. Overall, 17.8% of patients received BB only, 30.4% were treated exclusively with RASi, and 25.7% received a combination of both drugs. The mean age of the patients was 80.4 years (standard deviation 10.2 years), and 55.7% were women. In-hospital mortality was 7.3%. After multivariable adjustment, a significant association with lower mortality was found for treatment with BB alone (odds ratio [OR] = 0.826, 95% confidence interval [CI] 0.685-0.996), OR = 0.709 (CI95% 0.600-0.837) RASi alone and for combined treatment with RASi and BB (OR = 0.699, 95%CI 0.580-0.843). In the adjusted model with multiple imputation, the results remained significant.
CONCLUSIONS: In patients with an episode of AHF, baseline treatment with BB, RASi, or both is associated with lower all-cause mortality. This association is strongest in the group of patients receiving both treatments combined, and the results remain significant after multivariate adjustment.