Renin-Angiotensin System Inhibition and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries with Heart Failure

Kumar Sanam, Vikas Bhatia, Navkaranbir S. Bajaj, Saurabh Gaba, Charity J. Morgan, Gregg C. Fonarow, Javed Butler, Prakash Deedwania, Sumanth D. Prabhu, Wen Chih Wu, Michel White, Thomas E. Love, Wilbert S. Aronow, Ross D. Fletcher, Richard M. Allman, Ali Ahmed

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Background Heart failure is the leading cause for 30-day all-cause readmission, the reduction of which is a goal of the Affordable Care Act. There is a growing interest in understanding the impact of evidence-based heart failure therapy on 30-day all-cause readmission. In the current study, we examined the impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI-ARBs) on 30-day all-cause readmission in heart failure. Methods Of the 1384 hospitalized Medicare beneficiaries with heart failure and left ventricular ejection fraction <45% discharged alive from 106 Alabama hospitals (1998-2001) without prior ACEI-ARB use and without known contraindications to ACEI-ARB use; 734 received new predischarge prescriptions for these drugs. Using propensity scores for ACEI-ARB initiation, we assembled a matched cohort of 477 pairs of patients balanced on 32 baseline characteristics (mean age 75 years, 46% women, 26% African American). Results Thirty-day all-cause readmissions occurred in 18% and 24% of matched patients receiving and not receiving ACEI-ARBs, respectively (hazard ratio [HR] 0.74; 95% confidence interval [CI], 0.56-0.97; P = .030). ACEI-ARB use was also associated with lower risk of 30-day all-cause mortality (HR 0.56; 95% CI, 0.33-0.98; P = .041) and of the combined endpoint of 30-day all-cause readmission or 30-day all-cause mortality (HR 0.73; 95% CI, 0.56-0.94; P = .017). All associations remained significant at 1 year post discharge. Conclusions Among hospitalized patients with heart failure and reduced ejection fraction, the use of ACEI-ARBs was associated with a significantly lower risk of 30-day all-cause readmission and 30-day all-cause mortality; both beneficial associations persisted during long-term follow-up.

Original languageEnglish
Pages (from-to)1067-1073
Number of pages7
JournalAmerican Journal of Medicine
Issue number10
StatePublished - Oct 1 2016


  • ACEI or ARB
  • Heart failure
  • Hospital readmission


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