Angiotensin receptor blockers and outcomes in real-world older patients with heart failure and preserved ejection fraction: a propensity-matched inception cohort clinical effectiveness study

To examine the clinical effectiveness of angiotensin receptor blockers (ARBs) in older patients with heart failure and preserved ejection fraction (HF-PEF). Of the 10 570 hospitalized HF-PEF patients, aged epsilon 65 years, EF epsilon 40, in OPTIMIZE-HF (20032004), linked to Medicare data (up to 31 December 2008), 3806 were not receiving angiotensin-converting enzyme inhibitors or prior ARB therapy. Of these, 303 (8) patients received new discharge prescriptions for ARBs. Propensity scores for the receipt of ARBs, estimated for each of the 3806 patients, were used to assemble a cohort of 296 pairs of patients receiving and not receiving ARBs, who were balanced on 114 baseline characteristics. Patients had a mean age of 80 years, mean EF of 55, 69 were women, and 12 were African American. During 6 years of follow-up, the primary composite endpoint of all-cause mortality or HF hospitalization occurred in 79 (235/296) and 81 (241/296) of patients receiving and not receiving ARBs, respectively [hazard ratio (HR) associated with ARB use 0.88, 95 confidence interval (CI) 0.741.06; P 0.179]. ARB use had no association with individual endpoints of all-cause mortality (HR 0.93, 95 CI 0.761.14; P 0.509), HF hospitalization (HR 0.90, 95 CI, 0.721.14; P 0.389), or all-cause hospitalization (HR 0.91, 95 CI 0.771.08; P 0.265). These associations remained unchanged when we compared any (prevalent and new prescriptions) ARB use vs. non-use in a separately assembled propensity-matched cohort of 1137 pairs of HF-PEF patients. In real-world older HF-PEF patients, ARB use was not associated with improved clinical outcomes.