Impact of angiotensin converting enzyme inhibitors/angiotensin receptors blockers on mortality in acute heart failure patients with left ventricular systolic dysfunction in the Middle East: Observations from the Gulf Acute Heart Failure Registry (Gulf CARE).

AIMS: To evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptors blockers (ARBs) on in-hospital, 3- and 12-month all-cause mortality in acute heart failure (AHF) patients with left ventricular systolic dysfunction in 7 countries of the Middle East.

METHODS AND RESULTS: Data was analysed from 2,683 consecutive patients admitted with AHF and low ventricular ejection fraction (LVEF) (<40%) from 47 hospitals from February to November, 2012. Analyses were evaluated using univariate and multivariate statistical techniques. The overall mean age of the cohort was 58±15, 72% (n=1937) were males, 62% (n=1651) had coronary artery disease, 57% (n=1539) were hypertensives and 47% (n=1268) had diabetes. Overall cumulative mortality at in-hospital, 3- and 12-month follow-up was 5.8% (n=155), 12.6% (n=338) and 20.4% (n=548), respectively. Adjusting for demographic and clinical characteristics as well as medications use in the logistic regression model, ACEIs were associated with lower risk of in-hospital mortality (adjusted odds ratio (aOR), 0.48; 95% confidence interval (CI): 0.25 to 0.94; p=0.031). At 3-month follow-up, both ACEIs (aOR= 0.64; 95% CI: 0.43 to 0.95; p=0.025) and ARBs (aOR=0.34; 95% CI: 0.18 to 0.62; p<0.001) were associated with lower risk of mortality. Additionally at 12-month follow-up, those prescribed ACEIs (aOR, 0.71; 95% CI: 0.53 to 0.96; p=0.027) and ARBs (aOR, 0.47; 95% CI: 0.31 to 0.71; p<0.001) were still associated with lower risk of mortality.

CONCLUSIONS: ACEIs and ARBs treatments were associated with lower mortality risk during admission and up to 12-month of follow-up in Middle East AHF patients with left ventricular systolic dysfunction.