Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.
Department of Medicine, Lincoln Medical Center, New York, New York, USA.
Expert Rev Cardiovasc Ther. 2021 Nov;19(11):1037-1043. doi: 10.1080/14779072.2021.2004121. Epub 2021 Nov 22.
Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin-receptor blocker (ARB) are cornerstones in the treatment of heart failure with reduced ejection (HFrEF). However, there are limited data on their risk-benefit profile in patients with acute heart failure requiring hospitalizations.
We did a meta-analysis pooling data from all studies examining the use of ACEi/ARB in patients hospitalized for heart failure compared to patients without ACEi/ARB use. We calculated pooled hazard ratios (HR) and their 95% confidence intervals (CI) using a random-effects model.
Twenty-five studies were included in the meta-analysis. Continued use of ACEi/ARBs in hospitalized patients with HFrEF was associated with lower 1-year mortality risk (pooled HR 0.68 [0.60-0.77] < 0.001) and with lower 1-6-year mortality risk in those with heart failure preserved ejection fraction (HFpEF) (pooled HR 0.86 [0.78-0.94] = 0.002). There were significant reductions in 1-year HF readmissions among hospitalized HFrEF patients (pooled HR 0.83 [0.73-0.95] = 0.005).
Maintaining or initiating patients with HFrEF hospitalized for acute decompensated heart failure (ADHF) on ACEi/ARB is associated with a reduce risk of mortality and 1-year admissions, but the effect size is lower among those with HFpEF with more heterogeneous outcomes.
血管紧张素转换酶抑制剂（ACEi）和血管紧张素受体阻滞剂（ARB）是治疗射血分数降低的心力衰竭（HFrEF）的基石。然而，在因急性心力衰竭需要住院的患者中，关于它们的风险效益特征的数据有限。
我们进行了一项荟萃分析，汇总了所有研究中观察 ACEi/ARB 在因心力衰竭住院的患者与未使用 ACEi/ARB 的患者中的使用情况的数据。我们使用随机效应模型计算了汇总的危险比（HR）及其 95%置信区间（CI）。
共有 25 项研究纳入荟萃分析。HFrEF 住院患者继续使用 ACEi/ARB 与 1 年死亡率风险降低相关（汇总 HR 0.68 [0.60-0.77] < 0.001），HFpEF 患者 1-6 年死亡率风险降低（汇总 HR 0.86 [0.78-0.94] = 0.002）。HFrEF 住院患者 1 年 HF 再入院率显著降低（汇总 HR 0.83 [0.73-0.95] = 0.005）。
维持或启动因急性失代偿性心力衰竭（ADHF）住院的 HFrEF 患者使用 ACEi/ARB 与降低死亡率和 1 年住院率相关，但 HFpEF 患者的效果较小，且结局更具异质性。
