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- Edner, MagnusKarolinska Institutet (author)
Association between renin-angiotensin system antagonist use and mortality in heart failure with severe renal insufficiency: a prospective propensity score-matched cohort study
- Article/chapterEnglish2015
Publisher, publication year, extent ...
- 2015-06-11
- OXFORD UNIV PRESS,2015
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- LIBRIS-ID:oai:DiVA.org:liu-121745
- https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-121745URI
- https://doi.org/10.1093/eurheartj/ehv268DOI
- http://kipublications.ki.se/Default.aspx?queryparsed=id:131958966URI
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- Language:English
- Summary in:English
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- Funding Agencies|Swedish National Board of Health and Welfare; Swedish Association of Local Authorities and Regions; Swedish Society of Cardiology; Swedish Heart-Lung Foundation; Swedish Research Council from the Swedish Heart-Lung Foundation [2013-23897-104604-23, 20080409, 20100419]; Stockholm County Council [00556-2009, 20110120]
- Aims In heart failure (HF) with reduced ejection fraction (EF), renin-angiotensin receptor (RAS) antagonists reduce mortality. However, severe renal insufficiency was an exclusion criterion in trials. We tested the hypothesis that RAS antagonists are associated with reduced mortality also in HF with severe renal insufficiency. Methods and results We studied patients with EF less than= 39% registered in the prospective Swedish Heart Failure Registry. In patients with creatinine greater than221 mu mol/L or creatinine clearance less than30 mL/min, propensity scores for RAS-antagonist use were derived from 36 variables. The association between RAS antagonist use and all-cause mortality was assessed with Cox regression in a cohort matched 1:1 based on age and propensity score. To assess consistency, we performed the same analysis as a positive control in patients without severe renal insufficiency. Between 2000 and 2013, there were 24 283 patients of which 2410 [age, mean (SD), 82 (9), 45% women] had creatinine greater than221 mu mol/L or creatinine clearance less than30 mL/min and were treated (n = 1602) or not treated (n = 808) with RAS antagonists. In the matched cohort of 602 vs. 602 patients [age 83 (8), 42% women], RAS antagonist use was associated with 55% [95% confidence interval (CI) 51-59] vs. 45% (41-49) 1-year survival, P less than 0.001, with a hazard ratio (HR) for mortality of 0.76 (95% CI 0.67-0.86, P less than 0.001). In positive control patients without severe renal insufficiency [n = 21 873; age 71 (12), 27% women], the matched HR was 0.79 (95% CI 0.72-0.86, P less than 0.001). Conclusion In HF with severe renal insufficiency, the use of RAS antagonists was associated with lower all-cause mortality. Prospective randomized trials are needed before these findings can be applied to clinical practice.
Subject headings and genre
- MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin hsv//swe
- MEDICAL AND HEALTH SCIENCES Clinical Medicine hsv//eng
- Heart failure; Renin-angiotensin system antagonists; ACE-inhibitor; Angiotensin receptor blocker; Renal insufficiency; Chronic kidney disease; Creatinine clearance
Added entries (persons, corporate bodies, meetings, titles ...)
- Benson, LinaKarolinska Institutet (author)
- Dahlström, UlfLinköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US(Swepub:liu)ulfda85 (author)
- Lund, Lars H.Karolinska Institutet (author)
- Karolinska InstitutetAvdelningen för kardiovaskulär medicin (creator_code:org_t)
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- In:European Heart Journal: OXFORD UNIV PRESS36:34, s. 2318-23260195-668X1522-9645
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