Abstract
Objectives
Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers
(ARB) have shown antiarrhythmic effects that are useful as part of the upstream therapy
for atrial fibrillation (AF), both for primary and secondary prevention. Nevertheless,
the potential prognosis value of these drugs in terms of mortality and major cardiovascular
events is unclear, especially in older population with AF. Scientific evidence is
scarce in this population and shows contradictory results. The aim of this study was
to assess the potential benefit of ACEi and ARB in terms of mortality and major cardiovascular
outcomes (hospitalization for heart failure, acute myocardial infarction and stroke)
in older patients with AF, based on a real-world data analysis.
Design
Observational: analysis of a retrospective registry.
Settings and Participants
The study included 9365 patients of 75 years or older diagnosed with AF, from CardioCHUVI-AF_75
registry: ClinicalTrials.gov Identifier: NCT04364516. Date of registration: November 26, 2018.
Methods
We performed propensity score matching techniques to obtain 2 comparable groups of
3601 patients with and without ACEi or ARB treatment. We compared survival and cardiovascular
outcomes in both groups of patients using Cox proportional hazards models.
Results
We did not find significant differences in terms of survival between using or not
using ACEi or ARB for the older population (hazard ratio for mortality: 0.959, 95%
confidence interval 0.872–1.054). There were no significant differences regarding
cardiovascular major events between the 2 groups.
Conclusions and Implications
Treatment with ACEi or ARB did not improve outcomes in terms of survival and cardiovascular
events in older patients with AF. These results should prompt the conduct of randomized
clinical trials specifically in the older AF patient population to robustly address
this issue.
Keywords
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Article info
Publication history
Published online: February 16, 2021
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
