Supplementary Material for: Patterns of Use and Clinical Outcomes with Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Acute Heart Failure and Changes in Kidney Function: An Analysis of the Veterans’ Health Administrative Database

<b><i>Objective:</i></b> The aim of the study was to determine patterns and predictors of utilization of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) in patients with acute heart failure (AHF) and changes in kidney function at admission, hospitalization, and discharge in relation to clinical outcomes. <b><i>Methods:</i></b> This retrospective analysis of the Veterans’ Health Administration data (2016) included patients with heart failure (HF) with reduced ejection fraction who were hospitalized. Patients with an estimated glomerular filtration &lt;15 cm³/min/1.73 m² and those on dialysis were excluded. Patients were categorized based on the use of ACEI/ARB as continued, initiated, discontinued, or no therapy. Multivariable logistic regression evaluated predictors of being discharged home on an ACEI/ARB. Cox regression analysis evaluated outcomes (30 and 180-day mortality/HF readmissions). <b><i>Results:</i></b> 3,652 patients were included, of which 37% of patients hospitalized for AHF had ACEI/ARB discontinued on admission, or not initiated. After adjusting for age, blood pressure, and serum potassium, a per-unit increase in admission serum creatinine (SCr) was independently associated with lower rates of continuation or initiation of ACEI/ARB odds ratio 0.51 95% confidence interval (CI) (0.46–0.57). Discharge on ACEI/ARB was independently associated with lower odds of 30- and 180-day mortality hazard ratio (HR) 0.36 95% CI (0.25–0.52), and HR 0.23 95% CI (0.19–0.27), respectively. <b><i>Conclusion:</i></b> Higher SCr at admission is an important determinant of ACEI/ARB being discontinued or withheld in patients admitted with AHF. ACEI/ARB at discharge was associated with lower mortality in patients with AHF.

<b><i>研究目标：</i></b> 本研究旨在明确急性心力衰竭（acute heart failure, AHF）患者使用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂（angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, ACEI/ARBs）的模式与预测因素，以及入院、住院及出院阶段的肾功能变化与临床结局的关联。<b><i>研究方法：</i></b> 本研究对2016年退伍军人健康管理局（Veterans’ Health Administration）数据开展回顾性分析，纳入因射血分数降低型心力衰竭住院的患者。排除估算肾小球滤过率＜15 cm³/min/1.73 m²以及接受透析治疗的患者。根据ACEI/ARB的使用情况，将患者分为持续用药、初始用药、停药及未用药四组。采用多变量logistic回归分析评估出院时使用ACEI/ARB出院回家的预测因素；采用Cox回归分析评估临床结局（30天及180天死亡率/心力衰竭再住院率）。<b><i>研究结果：</i></b> 本研究共纳入3652例患者，其中37%因急性心力衰竭住院的患者在入院时停用ACEI/ARB或未启动该类药物治疗。校正年龄、血压及血清钾水平后，入院时血清肌酐（serum creatinine, SCr）每升高1个单位，与ACEI/ARB继续使用或初始使用的比例降低独立相关，比值比（odds ratio, OR）为0.51，95%置信区间（confidence interval, CI）为0.46~0.57。出院时使用ACEI/ARB与30天及180天死亡率降低独立相关，风险比（hazard ratio, HR）分别为0.36（95% CI：0.25~0.52）与0.23（95% CI：0.19~0.27）。<b><i>研究结论：</i></b> 入院时较高的血清肌酐水平是急性心力衰竭患者停用或暂缓使用ACEI/ARB的重要决定因素。出院时使用ACEI/ARB与急性心力衰竭患者的更低死亡率相关。