Baseline treatment with beta-blockers and renin-angiotensin system inhibitors and their association with adverse events in acute heart failure.

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.