RAS Inhibitors Associated With Lower One-Year Mortality, HF Readmission in TAVR Patients

TAVR patients who receive a prescription for a renin-angiotensin system (RAS) inhibitor at discharge may have lower rates of mortality and heart failure readmission after one year, according to a study recently published in the Journal of the American Medical Association.

Taku Inohara, MD, PhD, et al., used the STS/ACC TVT Registry to assess the association of prescription RAS inhibitors and TAVR outcome in 21,312 patients who underwent TAVR at 417 U.S. hospitals between July 2014 and January 2016. Primary outcomes were all-cause mortality and heart failure readmission at one year.

Among all patients, 39.7 percent received a prescription for a RAS inhibitor – including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers or both – at hospital discharge. The researchers then performed propensity matching to account for differences in demographics, echocardiographic findings and in-hospital complications among patients discharged with a RAS inhibitor prescription vs. without one. In the propensity-matched cohort of 15,896 patients, the average age was 82.4, 48.1 percent were women and the average left ventricular ejection fraction (LVEF) was 51.9 percent.

At one year post-TAVR, patients who received a RAS inhibitor prescription had lower mortality (12.5 percent vs. 14.9 percent) and lower heart failure readmission rates (12 percent vs. 13.8 percent). When stratified by LVEF status, having a RAS inhibitor prescription was associated with lower one-year mortality among patients with preserved LVEF (11.1 percent vs. 13.9 percent) but not among patients with reduced LVEF (18.8 percent vs. 19.5 percent).

According to the researchers, the study demonstrates that TAVR patients who receive a RAS inhibitor prescription at hospital discharge have a significantly lower risk of mortality and heart failure readmission after one year. They conclude that further research in randomized trials to confirm findings "due to potential selection bias."

Keywords: Angiotensin-Converting Enzyme Inhibitors, Renin-Angiotensin System, Patient Readmission, Transcatheter Aortic Valve Replacement, Angiotensin Receptor Antagonists, Patient Discharge, Heart Failure, Registries, National Cardiovascular Data Registries, STS/ACC TVT Registry, Echocardiography

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