{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:00:41Z","timestamp":1792677641459,"version":"4.5.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,2,2]]},"abstract":"\n Background<\/jats:title>\n \n Guidelines recommend continuation or initiation of guideline\u2010directed medical therapy, including angiotensin\u2010converting enzyme inhibitors\/angiotensin\n II<\/jats:styled-content>\n receptor blockers (\n ACE<\/jats:styled-content>\n i\/\n ARB<\/jats:styled-content>\n ), in hospitalized patients with heart failure with reduced ejection fraction.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Using the Get With The Guidelines\u2010Heart Failure Registry, we linked clinical data from 16\u00a0052 heart failure with reduced ejection fraction (ejection fraction \u226440%) patients with Medicare claims data. We divided\n ACE<\/jats:styled-content>\n i\/\n ARB<\/jats:styled-content>\n \u2010eligible patients into 4 categories based on admission and discharge\n ACE<\/jats:styled-content>\n i\/\n ARB<\/jats:styled-content>\n use: continued (reference group), started, discontinued, or not started on therapy. A multivariable Cox proportional hazard model was used to determine the association between\n ACE<\/jats:styled-content>\n i\/\n ARB<\/jats:styled-content>\n category and outcomes. Most, 90.5%, were discharged on\n ACE<\/jats:styled-content>\n i\/\n ARB<\/jats:styled-content>\n (59.6% continued and 30.9% newly started). Of those discharged without\n ACE<\/jats:styled-content>\n i\/\n ARB<\/jats:styled-content>\n , 1.9% were discontinued, and 7.5% were eligible but not started. Thirty\u2010day mortality was 3.5% for patients continued and 4.1% for patients started on\n ACE<\/jats:styled-content>\n i\/\n ARB<\/jats:styled-content>\n . In contrast, 30\u2010day mortality was 8.8% for patients discontinued (adjusted hazard ratio [\n HR<\/jats:styled-content>\n adj<\/jats:sub>\n ] 1.92; 95%\n CI<\/jats:styled-content>\n 1.32\u20102.81;\n P<\/jats:italic>\n <0.001) and 7.5% for patients not started (\n HR<\/jats:styled-content>\n adj<\/jats:sub>\n 1.50; 95%\n CI<\/jats:styled-content>\n 1.12\u20102.00;\n P<\/jats:italic>\n =0.006). The 30\u2010day readmission rate was lowest among patients continued or started on therapy. One\u2010year mortality was 28.2% for patients continued and 29.7% for patients started on\n ACE<\/jats:styled-content>\n i\/\n ARB<\/jats:styled-content>\n compared to 41.6% for patients discontinued (\n HR<\/jats:styled-content>\n adj<\/jats:sub>\n 1.35; 95%\n CI<\/jats:styled-content>\n 1.13\u20101.61;\n P<\/jats:italic>\n <0.001) and 41.7% (\n HR<\/jats:styled-content>\n adj<\/jats:sub>\n 1.28; 95%\n CI<\/jats:styled-content>\n 1.14\u20101.43;\n P<\/jats:italic>\n <0.001) for patients not started on therapy.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Compared with continuation, withdrawal of\n ACE<\/jats:styled-content>\n i\/\n ARB<\/jats:styled-content>\n during heart failure hospitalization is associated with higher rates of postdischarge mortality and readmission, even after adjustment for severity of illness.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.116.004675","type":"journal-article","created":{"date-parts":[[2017,2,12]],"date-time":"2017-02-12T01:10:15Z","timestamp":1486861815000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":131,"title":["Initiation, Continuation, or Withdrawal of Angiotensin\u2010Converting Enzyme Inhibitors\/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction"],"prefix":"10.1161","volume":"6","author":[{"given":"Lauren G.","family":"Gilstrap","sequence":"first","affiliation":[{"name":"Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ahmanson\u2010UCLA Cardiomyopathy Center, Ronald Reagan\u2010UCLA Medical Center, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshay S.","family":"Desai","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Liang","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Matsouaka","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam D.","family":"DeVore","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric E.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian F.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clyde W.","family":"Yancy","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak L.","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000350"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.125435"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198706043162301"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199108013250501"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199209033271003"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199209033271001"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.54.3.305"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31829e8807"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3182507bec"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.03.030"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2007.05.011"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.03.048"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2009.04.002"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.113.000163"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2013.01.033"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.13.1469"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi251"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000138934.28340.ED"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2011.02.322"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.170072"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(16)31550-9"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2016.05.008"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu364"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.01.041"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.116.004675","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:54:55Z","timestamp":1715597695000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.116.004675"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2,2]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017,2,2]]}},"alternative-id":["10.1161\/JAHA.116.004675"],"URL":"https:\/\/doi.org\/10.1161\/jaha.116.004675","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,2,2]]},"assertion":[{"value":"2016-09-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-12-28","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-02-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e004675"}}