Renin-angiotensin system blockade in heart failure patients on long-term haemodialysis in Taiwan

Chao Hsiun Tang, Tso Hsiao Chen, Chia Chen Wang, Chuang Ye Hong, Kuan Chih Huang, Yuh Mou Sue

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

AimsHeart failure is among the most frequent complications of patients on long-term haemodialysis. The benefits of renin-angiotensin system (RAS) blockade on the outcomes of these patients have yet to be determined.Methods and resultsWe conducted a nationwide observational study using data from the Taiwan National Health Insurance claims database, between 1999 and 2010. We enrolled patients aged ≥35 years with new-onset heart failure [diagnosed by International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM) codes] under treatment with medications. New users of a RAS blocker (RASB; i.e. an ACE inhibitor or an ARB used as monotherapy or dual therapy) were selected to compare with non-RASB users. We used Cox proportional hazards regression with and without propensity score adjustment to compare the risk of 3-year all-cause and cardiovascular mortality. Stratified analyses and RASB therapy duration as a time-dependent covariate were also performed. In all, 4771 were treated with an RASB (n = 3024) or without an RASB (n = 1747). RASB users had a higher prevalence of hypertension and diabetes, and a higher number of hospitalization. Among RASB users, 1148 deaths (38.0%) occurred during 5272 person-years of follow-up compared with 734 deaths (42.0%) among non-RASB users during 2683 person-years of follow-up. Three-year mortality rates were 45.4% and 49.1% for patients receiving and those not receiving an RASB, respectively (log-rank test, P <0.001). Adjusted hazard analysis revealed that RASB therapeutic effects remained significant on all-cause [hazard ratio (HR) 0.8; 95% confidence interval (CI) 0.72-0.89; P <0.001] and cardiovascular mortality (HR 0.76; 95% CI 0.64-0.90; P <0.01).ConclusionsRASB therapy reduced all-cause and cardiovascular mortality in heart failure patients on long-term haemodialysis.

Original languageEnglish
Pages (from-to)1194-1202
Number of pages9
JournalEuropean Journal of Heart Failure
Volume15
Issue number10
DOIs
Publication statusPublished - Oct 2013

Fingerprint

Renin-Angiotensin System
Taiwan
Renal Dialysis
Heart Failure
Mortality
Confidence Intervals
Propensity Score
National Health Programs
International Classification of Diseases
Therapeutic Uses
Therapeutics
Angiotensin-Converting Enzyme Inhibitors
Observational Studies
Hospitalization
Databases
Hypertension

Keywords

  • ACE inhibitor
  • ARB
  • Haemodialysis
  • Heart failure
  • Mortality
  • Renin-angiotensin system

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Renin-angiotensin system blockade in heart failure patients on long-term haemodialysis in Taiwan. / Tang, Chao Hsiun; Chen, Tso Hsiao; Wang, Chia Chen; Hong, Chuang Ye; Huang, Kuan Chih; Sue, Yuh Mou.

In: European Journal of Heart Failure, Vol. 15, No. 10, 10.2013, p. 1194-1202.

Research output: Contribution to journalArticle

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abstract = "AimsHeart failure is among the most frequent complications of patients on long-term haemodialysis. The benefits of renin-angiotensin system (RAS) blockade on the outcomes of these patients have yet to be determined.Methods and resultsWe conducted a nationwide observational study using data from the Taiwan National Health Insurance claims database, between 1999 and 2010. We enrolled patients aged ≥35 years with new-onset heart failure [diagnosed by International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM) codes] under treatment with medications. New users of a RAS blocker (RASB; i.e. an ACE inhibitor or an ARB used as monotherapy or dual therapy) were selected to compare with non-RASB users. We used Cox proportional hazards regression with and without propensity score adjustment to compare the risk of 3-year all-cause and cardiovascular mortality. Stratified analyses and RASB therapy duration as a time-dependent covariate were also performed. In all, 4771 were treated with an RASB (n = 3024) or without an RASB (n = 1747). RASB users had a higher prevalence of hypertension and diabetes, and a higher number of hospitalization. Among RASB users, 1148 deaths (38.0{\%}) occurred during 5272 person-years of follow-up compared with 734 deaths (42.0{\%}) among non-RASB users during 2683 person-years of follow-up. Three-year mortality rates were 45.4{\%} and 49.1{\%} for patients receiving and those not receiving an RASB, respectively (log-rank test, P <0.001). Adjusted hazard analysis revealed that RASB therapeutic effects remained significant on all-cause [hazard ratio (HR) 0.8; 95{\%} confidence interval (CI) 0.72-0.89; P <0.001] and cardiovascular mortality (HR 0.76; 95{\%} CI 0.64-0.90; P <0.01).ConclusionsRASB therapy reduced all-cause and cardiovascular mortality in heart failure patients on long-term haemodialysis.",
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AU - Huang, Kuan Chih

AU - Sue, Yuh Mou

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N2 - AimsHeart failure is among the most frequent complications of patients on long-term haemodialysis. The benefits of renin-angiotensin system (RAS) blockade on the outcomes of these patients have yet to be determined.Methods and resultsWe conducted a nationwide observational study using data from the Taiwan National Health Insurance claims database, between 1999 and 2010. We enrolled patients aged ≥35 years with new-onset heart failure [diagnosed by International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM) codes] under treatment with medications. New users of a RAS blocker (RASB; i.e. an ACE inhibitor or an ARB used as monotherapy or dual therapy) were selected to compare with non-RASB users. We used Cox proportional hazards regression with and without propensity score adjustment to compare the risk of 3-year all-cause and cardiovascular mortality. Stratified analyses and RASB therapy duration as a time-dependent covariate were also performed. In all, 4771 were treated with an RASB (n = 3024) or without an RASB (n = 1747). RASB users had a higher prevalence of hypertension and diabetes, and a higher number of hospitalization. Among RASB users, 1148 deaths (38.0%) occurred during 5272 person-years of follow-up compared with 734 deaths (42.0%) among non-RASB users during 2683 person-years of follow-up. Three-year mortality rates were 45.4% and 49.1% for patients receiving and those not receiving an RASB, respectively (log-rank test, P <0.001). Adjusted hazard analysis revealed that RASB therapeutic effects remained significant on all-cause [hazard ratio (HR) 0.8; 95% confidence interval (CI) 0.72-0.89; P <0.001] and cardiovascular mortality (HR 0.76; 95% CI 0.64-0.90; P <0.01).ConclusionsRASB therapy reduced all-cause and cardiovascular mortality in heart failure patients on long-term haemodialysis.

AB - AimsHeart failure is among the most frequent complications of patients on long-term haemodialysis. The benefits of renin-angiotensin system (RAS) blockade on the outcomes of these patients have yet to be determined.Methods and resultsWe conducted a nationwide observational study using data from the Taiwan National Health Insurance claims database, between 1999 and 2010. We enrolled patients aged ≥35 years with new-onset heart failure [diagnosed by International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM) codes] under treatment with medications. New users of a RAS blocker (RASB; i.e. an ACE inhibitor or an ARB used as monotherapy or dual therapy) were selected to compare with non-RASB users. We used Cox proportional hazards regression with and without propensity score adjustment to compare the risk of 3-year all-cause and cardiovascular mortality. Stratified analyses and RASB therapy duration as a time-dependent covariate were also performed. In all, 4771 were treated with an RASB (n = 3024) or without an RASB (n = 1747). RASB users had a higher prevalence of hypertension and diabetes, and a higher number of hospitalization. Among RASB users, 1148 deaths (38.0%) occurred during 5272 person-years of follow-up compared with 734 deaths (42.0%) among non-RASB users during 2683 person-years of follow-up. Three-year mortality rates were 45.4% and 49.1% for patients receiving and those not receiving an RASB, respectively (log-rank test, P <0.001). Adjusted hazard analysis revealed that RASB therapeutic effects remained significant on all-cause [hazard ratio (HR) 0.8; 95% confidence interval (CI) 0.72-0.89; P <0.001] and cardiovascular mortality (HR 0.76; 95% CI 0.64-0.90; P <0.01).ConclusionsRASB therapy reduced all-cause and cardiovascular mortality in heart failure patients on long-term haemodialysis.

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KW - Mortality

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