Yasuhiro Hamatani, Alexander Peikert, Brian L Claggett, Akshay S Desai, Pardeep S Jhund, Alasdair D Henderson, Carolyn S P Lam, Michele Senni, Sanjiv J Shah, Adriaan A Voors, Faiez Zannad, Bertram Pitt, James Lay-Flurrie, Andrea Lage, Lucas Hofmeister, John J V McMurray, Scott D Solomon, Muthiah Vaduganathan
Aims: Finerenone was shown to improve overall health status, as measured by the aggregate 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) score, in heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). This study aimed to contextualize KCCQ changes in a manner that is relevant to patients and clinicians, thereby improving understanding of this metric in HFmrEF/HFpEF.
Methods and results: In this prespecified analysis of FINEARTS-HF, a double-blind, randomized, placebo-controlled trial of finerenone in HFmrEF/HFpEF, we performed exploratory assessments of treatment effects on mean score changes from baseline to 12 months for each of the 23 KCCQ components (scaled from 0 [worst] to 100 [best]) using multivariable linear regression. We further compared the impact of finerenone on the KCCQ-overall summary score (KCCQ-OSS) at 12 months with the expected decline per year. Of 6,001 participants in FINEARTS-HF, 5,006 completed the KCCQ both at baseline and 12 months (age: 72±10 years, women: 45%, baseline KCCQ-OSS: 63.9±22.0). Finerenone, compared with placebo, numerically improved all but one KCCQ component, with the greatest nominal improvement observed in lower limb edema frequency (+2.5, 95%CI: 0.9-4.1), fatigue burden (+2.2, 95%CI: 0.9-3.5), fatigue frequency (+2.1, 95%CI: 0.7-3.6), and lower limb edema burden (+1.8, 95%CI: 0.6-2.9). KCCQ-OSS at 12 months was inversely related to age, with finerenone shifting the age-KCCQ-OSS relationship by 4.7 (95%CI: 0.4-9.1) years.
Conclusions: In FINEARTS-HF, finerenone was associated with modest improvements in health status-most notably lower limb edema and fatigue-in patients with HFmrEF/HFpEF.
Clinical trial registration: ClinicalTrials.gov ID NCT04435626.
{"title":"Finerenone and Quality of Life in Heart Failure: Component-Level Analyses and Clinical Relevance of the Kansas City Cardiomyopathy Questionnaire.","authors":"Yasuhiro Hamatani, Alexander Peikert, Brian L Claggett, Akshay S Desai, Pardeep S Jhund, Alasdair D Henderson, Carolyn S P Lam, Michele Senni, Sanjiv J Shah, Adriaan A Voors, Faiez Zannad, Bertram Pitt, James Lay-Flurrie, Andrea Lage, Lucas Hofmeister, John J V McMurray, Scott D Solomon, Muthiah Vaduganathan","doi":"10.1093/ejhf/xuag062","DOIUrl":"10.1093/ejhf/xuag062","url":null,"abstract":"<p><strong>Aims: </strong>Finerenone was shown to improve overall health status, as measured by the aggregate 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) score, in heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). This study aimed to contextualize KCCQ changes in a manner that is relevant to patients and clinicians, thereby improving understanding of this metric in HFmrEF/HFpEF.</p><p><strong>Methods and results: </strong>In this prespecified analysis of FINEARTS-HF, a double-blind, randomized, placebo-controlled trial of finerenone in HFmrEF/HFpEF, we performed exploratory assessments of treatment effects on mean score changes from baseline to 12 months for each of the 23 KCCQ components (scaled from 0 [worst] to 100 [best]) using multivariable linear regression. We further compared the impact of finerenone on the KCCQ-overall summary score (KCCQ-OSS) at 12 months with the expected decline per year. Of 6,001 participants in FINEARTS-HF, 5,006 completed the KCCQ both at baseline and 12 months (age: 72±10 years, women: 45%, baseline KCCQ-OSS: 63.9±22.0). Finerenone, compared with placebo, numerically improved all but one KCCQ component, with the greatest nominal improvement observed in lower limb edema frequency (+2.5, 95%CI: 0.9-4.1), fatigue burden (+2.2, 95%CI: 0.9-3.5), fatigue frequency (+2.1, 95%CI: 0.7-3.6), and lower limb edema burden (+1.8, 95%CI: 0.6-2.9). KCCQ-OSS at 12 months was inversely related to age, with finerenone shifting the age-KCCQ-OSS relationship by 4.7 (95%CI: 0.4-9.1) years.</p><p><strong>Conclusions: </strong>In FINEARTS-HF, finerenone was associated with modest improvements in health status-most notably lower limb edema and fatigue-in patients with HFmrEF/HFpEF.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov ID NCT04435626.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.8,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Targeting disease biology in peripartum cardiomyopathy: rethinking support in cardiogenic shock?","authors":"Julian Hoevelmann,Pardeep S Jhund,Charle Viljoen","doi":"10.1093/ejhf/xuag032","DOIUrl":"https://doi.org/10.1093/ejhf/xuag032","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"1 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial comment to: Influenza Vaccination in Acute Heart Failure: A Simple Shield for the \"Vulnerable Phase\".","authors":"Amina Rakisheva,Erzhan Suleimenov,Aidana Akanova,Aigul Raissova","doi":"10.1093/ejhf/xuag058","DOIUrl":"https://doi.org/10.1093/ejhf/xuag058","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"30 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pieter Martens,Iacopo Olivotto,Pablo Garcia-Pavia,Michelle Michels,Milind Y Desai,Wilfried Mullens
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease and a leading cause of heart failure and sudden cardiac death (SCD) in young adults. Given its complex pathophysiology, phenotypic diversity, and rapidly evolving therapeutic landscape, a structured and multidisciplinary approach to care is essential. This manuscript outlines a six-pillar framework to standardize and optimize evaluation and management of HCM. The proposed model organizes HCM care into six key domains. (i) Establishing the correct diagnosis, which requires differentiation between sarcomeric HCM and phenocopies such as amyloidosis, Fabry, or mitochondrial disease, using multimodal imaging and genetic testing. (ii) Establish presence of symptoms and of left ventricular outflow tract obstruction (LVOTO), which is central to symptom evaluation, prognostication, and treatment. Dynamic assessment with exercise echocardiography when required is essential to guide management, including pharmacotherapy or septal reduction therapy. (iii) Risk stratification for SCD integrates risk scores with adjunctive imaging data to support patient-centred implantable cardioverter defibrillator decisions. (iv) Genetic evaluation and family management enable cascade testing, early detection, and counselling. (v) Management of comorbidities-including atrial fibrillation, hypertension, obesity, and sleep-disordered breathing-is integral to holistic care and symptom control. (vi) Education and lifestyle guidance focus on safe sport participation, avoidance of dehydration and vasodilators, and reproductive counselling within a multidisciplinary setting.
{"title":"Comprehensive evaluation of hypertrophic cardiomyopathy: European Journal of Heart Failure expert consensus document.","authors":"Pieter Martens,Iacopo Olivotto,Pablo Garcia-Pavia,Michelle Michels,Milind Y Desai,Wilfried Mullens","doi":"10.1093/ejhf/xuag035","DOIUrl":"https://doi.org/10.1093/ejhf/xuag035","url":null,"abstract":"Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease and a leading cause of heart failure and sudden cardiac death (SCD) in young adults. Given its complex pathophysiology, phenotypic diversity, and rapidly evolving therapeutic landscape, a structured and multidisciplinary approach to care is essential. This manuscript outlines a six-pillar framework to standardize and optimize evaluation and management of HCM. The proposed model organizes HCM care into six key domains. (i) Establishing the correct diagnosis, which requires differentiation between sarcomeric HCM and phenocopies such as amyloidosis, Fabry, or mitochondrial disease, using multimodal imaging and genetic testing. (ii) Establish presence of symptoms and of left ventricular outflow tract obstruction (LVOTO), which is central to symptom evaluation, prognostication, and treatment. Dynamic assessment with exercise echocardiography when required is essential to guide management, including pharmacotherapy or septal reduction therapy. (iii) Risk stratification for SCD integrates risk scores with adjunctive imaging data to support patient-centred implantable cardioverter defibrillator decisions. (iv) Genetic evaluation and family management enable cascade testing, early detection, and counselling. (v) Management of comorbidities-including atrial fibrillation, hypertension, obesity, and sleep-disordered breathing-is integral to holistic care and symptom control. (vi) Education and lifestyle guidance focus on safe sport participation, avoidance of dehydration and vasodilators, and reproductive counselling within a multidisciplinary setting.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"108 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDThe effect of β-blockers on heart failure (HF) with preserved ejection fraction (HFpEF) remains controversial. One proposed reason is the confounding influence of common comorbidities such as atrial fibrillation (AF) and ischemic heart disease (IHD), which may obscure the influence of β-blockers on HFpEF outcomes.METHODS AND RESULTSFrom the PURSUIT-HFpEF registry (UMIN000021831), patients were divided into two groups: AF/IHD (with AF and/or IHD) and non-AF/IHD (without both). Prognosis was compared between β-blocker users and non-users in each group. Inverse probability of treatment weighting (IPTW) was performed as the primary adjustment method. In AF/IHD cohort (n=687; β-blocker 361, non-β-blocker 326), outcomes did not differ for the composite endpoint, all-cause death, or HF rehospitalization. In contrast, in non-AF/IHD patients (n=537; β-blocker 203, non-β-blocker 334), β-blocker use was linked to poorer outcomes. In IPTW-weighted analyses, β-blocker use was not associated with the composite endpoint, all-cause death, or HF rehospitalization in the AF/IHD group. In contrast, among non-AF/IHD patients, β-blocker use was associated with a higher risk of all-cause death (p=0.046, hazard ratio [HR] 1.448, 95% confidence interval [CI] 1.007-2.082) and cardiac death (p=0.001, HR 2.380, 95% CI 1.406-4.027), as well as a higher risk of cardiac composite outcomes (p=0.039, HR 1.441, 95% CI 1.018-2.039). Formal interaction testing between β-blocker use and AF/IHD status was not statistically significant across endpoints.CONCLUSIONSIn HFpEF patients without AF or IHD, β-blocker use was associated with higher mortality-related risk, indicating that routine β-blocker use in this subgroup should be interpreted with caution.
背景β受体阻滞剂对保留射血分数（HFpEF）的心力衰竭（HF）的影响仍存在争议。一个可能的原因是房颤（AF）和缺血性心脏病（IHD）等常见合并症的混杂影响，这可能掩盖了β受体阻滞剂对HFpEF结果的影响。方法和结果来自美国追踪- hfpef注册表（UMIN000021831），患者被分为两组：AF/IHD（伴有房颤和/或IHD）和非AF/IHD（两者均无）。比较各组β受体阻滞剂使用者和非使用者的预后。采用处理加权逆概率法（IPTW）作为主要调整方法。在AF/IHD队列中（n=687， β受体阻滞剂361，非β受体阻滞剂326），复合终点、全因死亡或HF再住院的结局没有差异。相反，在非房颤/IHD患者（n=537； β受体阻滞剂203，非β受体阻滞剂334）中，β受体阻滞剂的使用与较差的预后相关。在iptw加权分析中，β受体阻滞剂的使用与AF/IHD组的复合终点、全因死亡或HF再住院无关。相反，在非房颤/IHD患者中，β受体阻滞剂的使用与全因死亡（p=0.046，危险比[HR] 1.448, 95%可信区间[CI] 1.007-2.082）和心脏死亡（p=0.001，危险比2.380,95% CI 1.406-4.027）以及心脏复合结局的高风险相关（p=0.039，危险比1.441,95% CI 1.018-2.039）。β受体阻滞剂使用与房颤/IHD状态之间的正式相互作用测试在各终点间无统计学意义。结论在没有房颤或IHD的HFpEF患者中，β受体阻滞剂的使用与较高的死亡相关风险相关，表明在该亚组中常规使用β受体阻滞剂应谨慎解释。
{"title":"Are β-Blockers Necessary for Patients with Heart Failure with Preserved Ejection Fraction? : PurSuit-HFpEF Registry.","authors":"Masami Nishino,Yasuyuki Egami,Taichi Mukai,Mikako Kise,Ayako Sugino,Noriyuki Kobayashi,Masaru Abe,Hiroaki Nohara,Shodai Kawanami,Koji Yasumoto,Naotaka Okamoto,Yasuharu Matsunaga-Lee,Masamichi Yano,Takahisa Yamada,Yoshio Yasumura,Masahiro Seo,Takaharu Hayashi,Akito Nakagawa,Yusuke Nakagawa,Shunsuke Tamaki,Katsuki Okada,Yohei Sotomi,Daisaku Nakatani,Shungo Hikoso,Yasushi Sakata, ","doi":"10.1093/ejhf/xuag071","DOIUrl":"https://doi.org/10.1093/ejhf/xuag071","url":null,"abstract":"BACKGROUNDThe effect of β-blockers on heart failure (HF) with preserved ejection fraction (HFpEF) remains controversial. One proposed reason is the confounding influence of common comorbidities such as atrial fibrillation (AF) and ischemic heart disease (IHD), which may obscure the influence of β-blockers on HFpEF outcomes.METHODS AND RESULTSFrom the PURSUIT-HFpEF registry (UMIN000021831), patients were divided into two groups: AF/IHD (with AF and/or IHD) and non-AF/IHD (without both). Prognosis was compared between β-blocker users and non-users in each group. Inverse probability of treatment weighting (IPTW) was performed as the primary adjustment method. In AF/IHD cohort (n=687; β-blocker 361, non-β-blocker 326), outcomes did not differ for the composite endpoint, all-cause death, or HF rehospitalization. In contrast, in non-AF/IHD patients (n=537; β-blocker 203, non-β-blocker 334), β-blocker use was linked to poorer outcomes. In IPTW-weighted analyses, β-blocker use was not associated with the composite endpoint, all-cause death, or HF rehospitalization in the AF/IHD group. In contrast, among non-AF/IHD patients, β-blocker use was associated with a higher risk of all-cause death (p=0.046, hazard ratio [HR] 1.448, 95% confidence interval [CI] 1.007-2.082) and cardiac death (p=0.001, HR 2.380, 95% CI 1.406-4.027), as well as a higher risk of cardiac composite outcomes (p=0.039, HR 1.441, 95% CI 1.018-2.039). Formal interaction testing between β-blocker use and AF/IHD status was not statistically significant across endpoints.CONCLUSIONSIn HFpEF patients without AF or IHD, β-blocker use was associated with higher mortality-related risk, indicating that routine β-blocker use in this subgroup should be interpreted with caution.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"267 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mauro Riccardi,John W Ostrominski,Safia Chatur,Carlo M Lombardi,Maurizio Volterrani,Marco Metra,Gianluigi Savarese,Muthiah Vaduganathan,Scott D Solomon,Riccardo M Inciardi
{"title":"Effect of contemporary HFpEF therapies on diuretic management: Decongestive Role or Disease Modification?","authors":"Mauro Riccardi,John W Ostrominski,Safia Chatur,Carlo M Lombardi,Maurizio Volterrani,Marco Metra,Gianluigi Savarese,Muthiah Vaduganathan,Scott D Solomon,Riccardo M Inciardi","doi":"10.1093/ejhf/xuag074","DOIUrl":"https://doi.org/10.1093/ejhf/xuag074","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"253 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter regarding the article 'Beta-blockers in patients with heart failure with reduced ejection fraction and concomitant chronic obstructive pulmonary disease: Cardiovascular and respiratory outcomes'.","authors":"Yuanru Chai,Dawei Wang","doi":"10.1093/ejhf/xuag065","DOIUrl":"https://doi.org/10.1093/ejhf/xuag065","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"5 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michele D'Alto,George Giannakoulas,Jamil Aboulhosn,Teiji Akagi,Alexandra Arvanitaki,Roberto Badagliacca,Margarita Brida,Jeroen Bax,Konstantinos Dimopoulos,Pilar Escribano,Barbro Kjellström,Ewa Mroczek,Stephan Rosenkranz,Marc Humbert,Gerhard P Diller,Michael A Gatzoulis
For patients with pulmonary arterial hypertension (PAH), current guidelines recommend a 3- and 4-strata risk stratification model at baseline and follow-up, respectively. Risk stratification models in PAH are mainly derived from idiopathic PAH cohorts and are not automatically applicable to all patients with PAH associated with congenital heart disease (CHD), especially in those with Eisenmenger syndrome, given the differences in pathophysiology and clinical phenotype. Additional features such as shunt location, complexity of CHD, degree of cyanosis, iron deficiency, syndromic co-morbidity and biomarkers, other than brain natriuretic peptide may play an important role in the prognostication of these patients. This scientific statement aims to discuss in detail individual prognosticators and propose a comprehensive model of risk stratification for patients with PAH-CHD, mainly those with Eisenmenger syndrome.
{"title":"Risk stratification for adult patients with pulmonary arterial hypertension associated with congenital heart disease. A scientific statement of the ESC Working Group on Pulmonary Circulation & Right Ventricular Function, the ESC Working Group on Adult Congenital Heart Disease, and the Association of Cardiovascular Nursing & Allied Professions of the ESC.","authors":"Michele D'Alto,George Giannakoulas,Jamil Aboulhosn,Teiji Akagi,Alexandra Arvanitaki,Roberto Badagliacca,Margarita Brida,Jeroen Bax,Konstantinos Dimopoulos,Pilar Escribano,Barbro Kjellström,Ewa Mroczek,Stephan Rosenkranz,Marc Humbert,Gerhard P Diller,Michael A Gatzoulis","doi":"10.1093/ejhf/xuag059","DOIUrl":"https://doi.org/10.1093/ejhf/xuag059","url":null,"abstract":"For patients with pulmonary arterial hypertension (PAH), current guidelines recommend a 3- and 4-strata risk stratification model at baseline and follow-up, respectively. Risk stratification models in PAH are mainly derived from idiopathic PAH cohorts and are not automatically applicable to all patients with PAH associated with congenital heart disease (CHD), especially in those with Eisenmenger syndrome, given the differences in pathophysiology and clinical phenotype. Additional features such as shunt location, complexity of CHD, degree of cyanosis, iron deficiency, syndromic co-morbidity and biomarkers, other than brain natriuretic peptide may play an important role in the prognostication of these patients. This scientific statement aims to discuss in detail individual prognosticators and propose a comprehensive model of risk stratification for patients with PAH-CHD, mainly those with Eisenmenger syndrome.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"5 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amiya A Ahmed,Frederick Lu,Sijian Zhang,Venkatesh K Raman,Samir S Patel,Charity J Morgan,Charles Faselis,Phillip H Lam,Gregg C Fonarow,Paul A Heidenreich,Tariq Ahmad,Stefan D Anker,Marco Metra,Bertram Pitt,Javed Butler,Andrew R Zullo,Hans J Moore,Jose D Vargas,Cherinne Arundel,Carlos Andrés Sánchez-Vallejo,Prakash Deedwania,Helen M Sheriff,Qing Zeng-Treitler,Wen-Chih Wu,Ali Ahmed
AIMSIn patients with heart failure with reduced ejection fraction (HFrEF), target-dose (vs. below-target-dose) angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) improve clinical outcomes but worsen kidney function. Less is known about their effect on kidney failure (KF), especially in those with advanced chronic kidney disease (CKD), the examination of which was the objective of our study.METHODS AND RESULTSOf the 154,945 Veterans with HFrEF (EF≤40%) and no baseline KF, 134,046 were initiated on ACEIs (target-dose, n=37,667) and 20,899 were initiated on ARBs (target-dose, n=4017) during 2000-2018. While remaining blinded to study outcomes, we assembled two propensity score-matched cohorts: ACEI (N=70,860; target-dose, n=35,430) and ARB (N=7900; target-dose, n=3950), balanced on 76 baseline characteristics. Hazard ratios (95% CIs) associated with target doses were estimated for 5-year KF and all-cause mortality, up to December 31, 2023. In the ACEI cohort, target-dose was associated with a 18% lower risk of KF (HR, 0.82; 95% CI, 0.75-0.89) and a 6% lower risk of death (HR, 0.94; 95% CI, 0.92-0.97). Subgroup and spline analyses showed that while the KF association was significant for those with baseline eGFR <35 ml/min/1.73m2, the mortality association was significant for those with eGFR ≥35 ml/min/1.73m2. In the ARB cohort, target-dose had no association with outcomes.CONCLUSIONSIn patients with HFrEF, target-dose (vs. below-target-dose) ACEIs, but not ARBs, were associated with lower risk of KF, which was significant in those with advanced CKD. The survival benefit was modest and limited to those without advanced CKD.
{"title":"Target-Dose Versus Below-Target-Dose ACE Inhibitors and Lower Risk of Kidney Failure in U.S. Veterans with HFrEF.","authors":"Amiya A Ahmed,Frederick Lu,Sijian Zhang,Venkatesh K Raman,Samir S Patel,Charity J Morgan,Charles Faselis,Phillip H Lam,Gregg C Fonarow,Paul A Heidenreich,Tariq Ahmad,Stefan D Anker,Marco Metra,Bertram Pitt,Javed Butler,Andrew R Zullo,Hans J Moore,Jose D Vargas,Cherinne Arundel,Carlos Andrés Sánchez-Vallejo,Prakash Deedwania,Helen M Sheriff,Qing Zeng-Treitler,Wen-Chih Wu,Ali Ahmed","doi":"10.1093/ejhf/xuag076","DOIUrl":"https://doi.org/10.1093/ejhf/xuag076","url":null,"abstract":"AIMSIn patients with heart failure with reduced ejection fraction (HFrEF), target-dose (vs. below-target-dose) angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) improve clinical outcomes but worsen kidney function. Less is known about their effect on kidney failure (KF), especially in those with advanced chronic kidney disease (CKD), the examination of which was the objective of our study.METHODS AND RESULTSOf the 154,945 Veterans with HFrEF (EF≤40%) and no baseline KF, 134,046 were initiated on ACEIs (target-dose, n=37,667) and 20,899 were initiated on ARBs (target-dose, n=4017) during 2000-2018. While remaining blinded to study outcomes, we assembled two propensity score-matched cohorts: ACEI (N=70,860; target-dose, n=35,430) and ARB (N=7900; target-dose, n=3950), balanced on 76 baseline characteristics. Hazard ratios (95% CIs) associated with target doses were estimated for 5-year KF and all-cause mortality, up to December 31, 2023. In the ACEI cohort, target-dose was associated with a 18% lower risk of KF (HR, 0.82; 95% CI, 0.75-0.89) and a 6% lower risk of death (HR, 0.94; 95% CI, 0.92-0.97). Subgroup and spline analyses showed that while the KF association was significant for those with baseline eGFR <35 ml/min/1.73m2, the mortality association was significant for those with eGFR ≥35 ml/min/1.73m2. In the ARB cohort, target-dose had no association with outcomes.CONCLUSIONSIn patients with HFrEF, target-dose (vs. below-target-dose) ACEIs, but not ARBs, were associated with lower risk of KF, which was significant in those with advanced CKD. The survival benefit was modest and limited to those without advanced CKD.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"15 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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