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Prescription of renin-angiotensin system blockers linked to lower HF readmission rates
WASHINGTON — New research suggests that discharge prescription of ACE inhibitors or angiotensin receptor blockers may be associated with significantly lower risk for all-cause readmission, HF readmission and all-cause mortality at 30 days in hospitalized patients who have HF with reduced ejection fraction.
In a study of 954 Medicare beneficiaries discharged after hospitalization for HF with reduced ejection fraction (HFrEF; left ventricular ejection fraction <45%), 18% of those prescribed ACE inhibitors or angiotensin receptor blockers at discharge were readmitted to the hospital for any reason within 30 days, whereas 24% of those not prescribed the drugs were readmitted (HR=0.74; 95% CI, 0.56-0.97).
Kumar Sanam, MD, advanced HF and heart transplant fellow at the University of Alabama at Birmingham, presented the findings at the American College of Cardiology Scientific Sessions.
Kumar Sanam
Sanam and colleagues also found that the following outcomes were more favorable among patients prescribed ACE inhibitors or angiotensin receptor blockers compared with those who did not receive prescriptions:
- 30-day HF readmission (HR=0.52; 95% CI, 0.35-0.79).
- 30-day all-cause mortality (HR=0.56; 95% CI, 0.33-0.98).
- 30-day all-cause mortality or all-cause readmission (HR=0.73; 95% CI, 0.56-0.94).
Similar results were observed at 1 year after discharge, Sanam said at a press conference.
“These findings suggest that these evidence-based, guideline-recommended drugs may serve as an inexpensive tool to tackle a costly health care problem of this nation,” he said.
The findings are important, Sanam said, because the Affordable Care Act allows the US government to levy financial penalties on hospitals with above-average 30-day readmission rates, which is projected to cost hospitals $7 billon over the next 10 years, and because HF is the leading reason among Medicare beneficiaries for 30-day all-cause readmission. Patients with HF at discharge have a 26.9% all-cause 30-day readmission rate, compared with 21% for those with any medical condition and 15.9% for those who underwent any surgical procedure, he said. – by Erik Swain
For more information:
Sanam K. Abstract #1186-204. Presented at: American College of Cardiology Scientific Sessions; March 29-31, 2014; Washington, D.C.
Disclosure: Sanam reports no relevant financial disclosures.
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I think the findings are very important. The underprescription of ACE inhibitors and angiotensin receptor blockers has been known for some time. It is also known, particularly among the elderly Medicare population with abnormal renal function, that the benefit of ACE inhibitors is very clear. However, the underprescribing pattern is also very clear in every data set, outpatient and inpatient.
This study adds more evidence to document that clinicians, are not using evidence-based drugs for hospitalized patients, either because we are poor at documentation of contraindications or because we are afraid to use them at a time of hospitalization. That may be because the patient is frail, has lower BP or has had other medications changed. However, these data are compelling as they show a mortality benefit.