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Comparative associa...
Comparative associations between angiotensin converting enzyme inhibitors, angiotensin receptor blockers and their combination, and outcomes in patients with heart failure and reduced ejection fraction
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- Savarese, Gianluigi (författare)
- Karolinska Institutet
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- Edner, Magnus (författare)
- Karolinska Institutet
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- Dahlström, Ulf (författare)
- Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
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- Perrone-Filardi, Pasquale (författare)
- University of Naples Federico II, Italy
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- Hage, Camilla (författare)
- Karolinska Institutet
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- Cosentino, Francesco (författare)
- Karolinska Institutet
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- Lund, Lars H. (författare)
- Karolinska Institutet
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(creator_code:org_t)
- ELSEVIER IRELAND LTD, 2015
- 2015
- Engelska.
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Ingår i: International Journal of Cardiology. - : ELSEVIER IRELAND LTD. - 0167-5273 .- 1874-1754. ; 36, s. 22-23
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- Background: Angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are recommended in heart failure with reduced ejection fraction (HFREF), but there is limited data on ARB vs. ACE-I and their combination in unselected populations. The purpose of this study was to compare the associations between the use of ACE-I, ARB and their combination, and outcomes in HFREF. Methods and results: We prospectively studied 22,947 patients with HFREF (ejection fraction b 40%) enrolled in the Swedish Heart Failure Registry who received ACE-I but not ARB (n = 15,801, 69%), ARB but not ACE-I (n = 4335, 19%), their combination (n = 571, 2%) or neither (n = 2240, 10%). As compared with ACE-I alone, the hazard ratios (HRs) for ARB alone for all-cause mortality was 0.97 (95% CI = 0.91-1.03; p = 0.27), for HF hospitalization 1.08 (CI = 1.02-1.15; p less than 0.01) and for the composite outcome 1.03 (CI = 0.99-1.08; p = 0.15). ACE-I and ARB combination had for death HR = 0.98 (95% CI = 0.84-1.14; p = 0.76), for HF hospitalization HR = 1.49 (CI = 1.33-1.68; p less than 0.01) and for the composite outcome HR = 1.35 (CI = 1.21-1.50; p less than 0.01). Use of neither ACE-I nor ARB was associated with HR for death 1.41 (CI = 1.33-1.50; p less than 0.01), for HF hospitalization 1.16 (CI = 1.08-1.25; p less than 0.01) and for the composite outcome 1.28 (CI = 1.21-1.35; p less than 0.01). Conclusion: This large generalizable analysis confirms the current recommendation of using ACE-I as first choice in HFREF. ARB can be considered an alternative in patients who cannot use ACE-I but should not routinely replace ACE-I. The combination of ACE-I and ARB was not associated with additional benefit over either one alone, and may potentially be harmful. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
Nyckelord
- Heart failure with reduced ejection fraction; Angiotensin converting enzyme inhibitors; Angiotensin receptor blockers; Registry; Prognosis
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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