SPC365

Use of renin-angiotensin-aldosteron inhibitors (RASSi) and dose-related outcomes in older adults

Session: Posters - D. Heart Failure
Speaker: Sara Cristina da Silva Borges

Congress: CPC 2021
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Posters
FP Number: ---
Authors: Sara Borges; José João Monteiro; Pedro Carvalho; Catarina Ribeiro Carvalho; Marta Catarina Bernardo; Miguel Moz; Ana Baptista; Catarina Ferreira; j. Ilídio Moreira
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">BACKGROUND: &nbsp;Renin-angiotensin-aldosteron inhibitors (RASSi) are<span style="background-color:white"><span style="color:black"> recommended as first-line therapy in heart failure (HF) with reduced ejection fraction patients, and </span></span>should be up-titrated to maximally tolerated or target dose. Their benefit in older patients is less established since they are &nbsp;frequently underrepresented in clinical trials;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">AIM: </span></span></span>&nbsp;<span style="font-family:&quot;Calibri Light&quot;,sans-serif">To determine whether RASSi therapy is beneficial, and the relative benefits of high- relative to lower-dose therapy in routine clinical practice in older patients;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">METHODS: Retrospective study of consecutive patients admitted in </span><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">heart failure clinic of a cardiology center from February/2018 to December/2020, </span></span></span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">with an initial left ventricular ejection fraction (LVEF) &lt;40%;<span style="background-color:white"><span style="color:black"> Primary outcomes were all-cause mortality</span></span> and a composite of death, HF hospitalizations or emergency department admission; Low dose was defined as &lt;50% of target dose.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">RESULTS: <span style="background-color:white"><span style="color:black">We included 264 patients (mean age 71&plusmn; 11 years; 69% males; ~40% ischemic etiology). Off this, 31% (83 pts) had 80 years or more. Older patients had lower weight (63 &plusmn;12Kg vs 74&plusmn;15Kg p&lt;0.001, lower haemoglobin levels (13.8 vs 12.5g/dL, p&lt;0,001) and </span></span>higher&nbsp;baseline serum creatinine (0.9 vs 1.1mg/dL, p&lt;0.001).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Within patients &gt;80 years, 17% (14) didn&rsquo;t tolerate any dose of RASSi, 27% (22) tolerated low doses and 56% were on high doses of RASSi.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">After a median follow-up of 17 months (IQR 19&ndash;51), 18 patients died (22%) and 36 (43%) had composite endpoint. &nbsp;</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">In eldery, therapy with any dose of RASSi was associated with improved survival (HR 2.4 95% CI 1,1-5.1, log rank p= 0.02). However, when compared with low doses, higher dosis does not provide additional reduction in mortality (HR 1.7 95% CI 0.8-3.6, p=0.187) or in the combined endopoint of death, HF hospitalizations or emergency department admissions (HR 1.2 95% CI&nbsp; 0.5-2.6, p= 0.658) in this patients.</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">CONCLUSION</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Our study suggests that RASSi therapy does provide a survival benefit in older patients compared to not receiving any ACE inhibitor therapy but its unclear if they benefit of target dosis.&nbsp; Accordingly, optimal doses for older patients may be lower than those studied in trials or tolerated in younger patients. </span></span></span></p>