Most heart failure (HF) patients suffer from chronic kidney disease (CKD). HF patients with CKD have one of the poorest prognoses, yet they are also least likely to receive life-saving medications such as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB). There have been no randomized controlled trials (RCT) of ACEI/ARB in HF-CKD patients to guide clinical practice, and none are likely to be conducted soon. Moreover, clinicians often perceive ACE/AB-associated rise in serum creatinine as an indication of renal damage. This belief and practice engrained in traditional teaching is unlikely to change without strong evidence of survival benefit of ACEI/ARB in HF-CKD patients. Our specific hypothesis is that ACEI/ARB would reduce mortality and hospitalization in HF patients with CKD. We base our hypothesis on the fact that activation of the renin-angiotensin system (RAS) forms the basis of the pathogenesis and progression of both HF and CKD, suppression of which forms the basis of cardio- and reno-protective properties of ACEI/ARB. Therefore, we postulate that patients with both HF and CKD will benefit from these drugs. Alabama HF Project (AHFP) is a large (8555 patients from 106 hospitals), recent (1998-2001), and rich dataset with -200 well-defined variables including serum creatinine, ejection fraction, and medications. The AHFP cohort closely resembles real-life HF patients in terms of age (mean 77 years) and diversity (>50% women, > 20% non-whites), allowing the assessment of patients often excluded from RCT. In addition, Studies of Left Ventricular Dysfunction (SOLVD) (N=2569; 83 hospitals; mean age 61 years, 20% women, 20% nonwhite) data will be use to study the effect of ACEI of ambulatory systolic HF patients with CKD.
The specific aims of this study are to determine the effects of ACEI/ARB on mortality and hospitalization in systolic and diastolic HF patients with CKD, and the effect of ARB (versus ACEI) on mortality and hospitalization in HF-CKD patients using propensity score technique. Our long-term goal is to produce strong evidence, based on a rigorously designed and conducted non- randomized study, which will challenge existing clinical practice of nonuse/underuse of ACEI/ARB in HF- CKD patients, and improve quality and outcomes of HF care. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL085561-03
Application #
7433751
Study Section
Clinical and Integrative Cardiovascular Sciences Study Section (CICS)
Program Officer
Evans, Frank
Project Start
2006-08-15
Project End
2010-05-31
Budget Start
2008-06-01
Budget End
2009-05-31
Support Year
3
Fiscal Year
2008
Total Cost
$317,881
Indirect Cost
Name
University of Alabama Birmingham
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
063690705
City
Birmingham
State
AL
Country
United States
Zip Code
35294
Lam, Phillip H; Dooley, Daniel J; Fonarow, Gregg C et al. (2018) Similar clinical benefits from below-target and target dose enalapril in patients with heart failure in the SOLVD Treatment trial. Eur J Heart Fail 20:359-369
Arundel, Cherinne; Sheriff, Helen; Bearden, Donna M et al. (2018) Discharge home health services referral and 30-day all-cause readmission in older adults with heart failure. Arch Med Sci 14:995-1002
Sheriff, Helen M; Tsimploulis, Apostolos; Valentova, Miroslava et al. (2017) Isolated diastolic hypertension and incident heart failure in community-dwelling older adults: Insights from the Cardiovascular Health Study. Int J Cardiol 238:140-143
Lam, Phillip H; Dooley, Daniel J; Inampudi, Chakradhari et al. (2017) Lack of evidence of lower 30-day all-cause readmission in Medicare beneficiaries with heart failure and reduced ejection fraction discharged on spironolactone. Int J Cardiol 227:462-466
Sheriff, Helen M; Thogaripally, Manik R; Panjrath, Gurusher et al. (2017) Digoxin and 30-Day All-Cause Readmission in Long-Term Care Residents Hospitalized for Heart Failure. J Am Med Dir Assoc 18:761-765
Tsimploulis, Apostolos; Sheriff, Helen M; Lam, Phillip H et al. (2017) Systolic-diastolic hypertension versus isolated systolic hypertension and incident heart failure in older adults: Insights from the Cardiovascular Health Study. Int J Cardiol 235:11-16
Arundel, Cherinne; Lam, Phillip H; Khosla, Rahul et al. (2016) Association of 30-Day All-Cause Readmission with Long-Term Outcomes in Hospitalized Older Medicare Beneficiaries with Heart Failure. Am J Med 129:1178-1184
Sanam, Kumar; Bhatia, Vikas; Bajaj, Navkaranbir S et al. (2016) Renin-Angiotensin System Inhibition and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries with Heart Failure. Am J Med 129:1067-73
Abdelmawgoud, Ahmed; Brown, Cynthia J; Sui, Xuemei et al. (2015) Relationship of Physical Activity and Healthy Eating with Mortality and Incident Heart Failure among Community-Dwelling Older Adults with Normal Body Mass Index. ESC Heart Fail 2:20-24
Kheirbek, Raya E; Fletcher, Ross D; Bakitas, Marie A et al. (2015) Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure. Circ Heart Fail 8:733-40

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