After transcatheter aortic valve replacement (TAVR), treatment with a renin-angiotensin system (RAS) inhibitor at hospital discharge is associated with lower risk of mortality and heart failure–related readmission, according to an analysis of Medicare patients.
RAS inhibitors may reverse left ventricular remodeling and improve function, which could explain the association, noted lead investigator.
The researchers analyzed data from consecutive Medicare patients who underwent TAVR, drawn from the Society of Thoracic Surgeons/American College of Cardiology TVT. They included 15,896 propensity-matched patients from 417 U.S. centers.
At 1 year, a RAS inhibitor prescription at discharge was linked to a statistically significant relative 18% reduction in all-cause mortality (12.5% vs. 14.9%) and a 16% drop in heart failure readmissions (12.0% vs. 13.8%).
The researchers conducted a propensity-scored analysis of 12,942 patients with preserved left ventricular ejection fraction (greater than 40%) and 2,954 with LVEF up to 40%. In the preserved LVEF group, RAS inhibitor prescription was associated with a significant 22% reduction in mortality (11.1% vs. 13.9%), but there was no statistically significant association in patients with reduced LVEF (18.8% vs. 19.5%).
There was no clinically meaningful difference in quality of life between those who received a RAS inhibitor and those who did not, but the subgroup analysis could be performed on only 30% of the overall cohort, Dr. Inohara and his colleagues at the Duke Clinical Research Center in Durham, N.C., wrote.
They added that most patients undergoing TAVR are eligible for RAS inhibitors because of frequently comorbid hypertension, coronary artery disease, and renal dysfunction.
The study was funded by the American College of Cardiology Foundation’s National Cardiovascular Data Registry and the Society of Thoracic Surgeons. Study authors have wide-ranging financial relationships with pharmaceutical companies.
SOURCE: Inohara T et al.