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The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation

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The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation : a large population cohort study. / Elder, Douglas H. J.; Wei, Li; Szwejkowski, Benjamin R.; Libianto, Renata; Nadir, Adnan; Pauriah, Maheshwar; Rekhraj, Sushma; Lim, Tiong K.; George, Jacob; Doney, Alex; Pringle, Stuart D.; Choy, Anna-Maria; Struthers, Allan D.; Lang, Chim C.

In: Journal of the American College of Cardiology, Vol. 58, No. 20, 11.2011, p. 2084-2091.

Research output: Contribution to journalArticle

Harvard

Elder, DHJ, Wei, L, Szwejkowski, BR, Libianto, R, Nadir, A, Pauriah, M, Rekhraj, S, Lim, TK, George, J, Doney, A, Pringle, SD, Choy, A-M, Struthers, AD & Lang, CC 2011, 'The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation: a large population cohort study' Journal of the American College of Cardiology, vol 58, no. 20, pp. 2084-2091., 10.1016/j.jacc.2011.07.043

APA

Elder, D. H. J., Wei, L., Szwejkowski, B. R., Libianto, R., Nadir, A., Pauriah, M., ... Lang, C. C. (2011). The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation: a large population cohort study. Journal of the American College of Cardiology, 58(20), 2084-2091. 10.1016/j.jacc.2011.07.043

Vancouver

Elder DHJ, Wei L, Szwejkowski BR, Libianto R, Nadir A, Pauriah M et al. The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation: a large population cohort study. Journal of the American College of Cardiology. 2011 Nov;58(20):2084-2091. Available from: 10.1016/j.jacc.2011.07.043

Author

Elder, Douglas H. J.; Wei, Li; Szwejkowski, Benjamin R.; Libianto, Renata; Nadir, Adnan; Pauriah, Maheshwar; Rekhraj, Sushma; Lim, Tiong K.; George, Jacob; Doney, Alex; Pringle, Stuart D.; Choy, Anna-Maria; Struthers, Allan D.; Lang, Chim C. / The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation : a large population cohort study.

In: Journal of the American College of Cardiology, Vol. 58, No. 20, 11.2011, p. 2084-2091.

Research output: Contribution to journalArticle

Bibtex - Download

@article{26ba51b775eb489b9faefdff11472883,
title = "The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation: a large population cohort study",
keywords = "Angiotensin-converting enzyme inhibitors, Angiotensin receptor blockers, Aortic regurgitation, Converting enzyme inhibitor, Term vasodilator therapy, Chronic volume overload, Asymptomatic patients, Mitral regurgitation, Myocardial infarction, Valve regurgitation, Left ventricle, Insufficiecy, Nifedipine",
author = "Elder, {Douglas H. J.} and Li Wei and Szwejkowski, {Benjamin R.} and Renata Libianto and Adnan Nadir and Maheshwar Pauriah and Sushma Rekhraj and Lim, {Tiong K.} and Jacob George and Alex Doney and Pringle, {Stuart D.} and Anna-Maria Choy and Struthers, {Allan D.} and Lang, {Chim C.}",
year = "2011",
doi = "10.1016/j.jacc.2011.07.043",
volume = "58",
number = "20",
pages = "2084--2091",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation

T2 - a large population cohort study

A1 - Elder,Douglas H. J.

A1 - Wei,Li

A1 - Szwejkowski,Benjamin R.

A1 - Libianto,Renata

A1 - Nadir,Adnan

A1 - Pauriah,Maheshwar

A1 - Rekhraj,Sushma

A1 - Lim,Tiong K.

A1 - George,Jacob

A1 - Doney,Alex

A1 - Pringle,Stuart D.

A1 - Choy,Anna-Maria

A1 - Struthers,Allan D.

A1 - Lang,Chim C.

AU - Elder,Douglas H. J.

AU - Wei,Li

AU - Szwejkowski,Benjamin R.

AU - Libianto,Renata

AU - Nadir,Adnan

AU - Pauriah,Maheshwar

AU - Rekhraj,Sushma

AU - Lim,Tiong K.

AU - George,Jacob

AU - Doney,Alex

AU - Pringle,Stuart D.

AU - Choy,Anna-Maria

AU - Struthers,Allan D.

AU - Lang,Chim C.

PY - 2011/11

Y1 - 2011/11

N2 - <p>Objectives The aim of this study was to investigate the effect of renin-angiotensin system blockade on outcomes in patients with aortic regurgitation (AR).</p><p>Background Angiotensin-converting enzyme (ACE) inhibitors have the potential to reduce afterload, blunt left ventricular wall stress, and limit left ventricular dilation and hypertrophy. However, long-term studies have yielded inconsistent results, and very few have assessed clinical outcomes.</p><p>Methods The Health Informatics Centre dispensed prescription and morbidity and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database. Patients diagnosed with at least moderate AR from 1993 to 2008 were identified. Cox regression analysis was used to assess differences in all-cause mortality and cardiovascular (CV) and AR events (heart failure hospitalizations, heart failure deaths, or aortic valve replacement) between those treated with and without ACE inhibitors or angiotensin receptor blockers (ARBs).</p><p>Results A total of 2,266 subjects with AR (median age 74 years; interquartile range: 64 to 81 years) were studied, with a mean follow-up period of 4.4 +/- 3.7 years. Seven hundred and five patients (31%) received ACE inhibitor or ARB therapy. There were 582 all-cause deaths (25.7%). Patients treated with ACE inhibitors or ARBs had significantly lower all-cause mortality and fewer CV and AR events, with adjusted hazard ratios of 0.56 (95% confidence interval [CI]: 0.64 to 0.89; p &lt; 0.01) for all-cause mortality, 0.77 (95% CI: 0.67 to 0.89; p &lt; 0.01) for CV events, and 0.68 (95% CI: 0.54 to 0.87; p &lt; 0.01) for AR events.</p><p>Conclusions This large retrospective study shows that the prescription of ACE inhibitors or ARBs in patients with moderate to severe AR was associated with significantly reduced all-cause mortality and CV and AR events. These data need to be confirmed by a prospective randomized controlled outcome trial. (J Am Coll Cardiol 2011;58:2084-91) (C) 2011 by the American College of Cardiology Foundation</p>

AB - <p>Objectives The aim of this study was to investigate the effect of renin-angiotensin system blockade on outcomes in patients with aortic regurgitation (AR).</p><p>Background Angiotensin-converting enzyme (ACE) inhibitors have the potential to reduce afterload, blunt left ventricular wall stress, and limit left ventricular dilation and hypertrophy. However, long-term studies have yielded inconsistent results, and very few have assessed clinical outcomes.</p><p>Methods The Health Informatics Centre dispensed prescription and morbidity and mortality database for the population of Tayside, Scotland, was linked through a unique patient identifier to the Tayside echocardiography database. Patients diagnosed with at least moderate AR from 1993 to 2008 were identified. Cox regression analysis was used to assess differences in all-cause mortality and cardiovascular (CV) and AR events (heart failure hospitalizations, heart failure deaths, or aortic valve replacement) between those treated with and without ACE inhibitors or angiotensin receptor blockers (ARBs).</p><p>Results A total of 2,266 subjects with AR (median age 74 years; interquartile range: 64 to 81 years) were studied, with a mean follow-up period of 4.4 +/- 3.7 years. Seven hundred and five patients (31%) received ACE inhibitor or ARB therapy. There were 582 all-cause deaths (25.7%). Patients treated with ACE inhibitors or ARBs had significantly lower all-cause mortality and fewer CV and AR events, with adjusted hazard ratios of 0.56 (95% confidence interval [CI]: 0.64 to 0.89; p &lt; 0.01) for all-cause mortality, 0.77 (95% CI: 0.67 to 0.89; p &lt; 0.01) for CV events, and 0.68 (95% CI: 0.54 to 0.87; p &lt; 0.01) for AR events.</p><p>Conclusions This large retrospective study shows that the prescription of ACE inhibitors or ARBs in patients with moderate to severe AR was associated with significantly reduced all-cause mortality and CV and AR events. These data need to be confirmed by a prospective randomized controlled outcome trial. (J Am Coll Cardiol 2011;58:2084-91) (C) 2011 by the American College of Cardiology Foundation</p>

KW - Angiotensin-converting enzyme inhibitors

KW - Angiotensin receptor blockers

KW - Aortic regurgitation

KW - Converting enzyme inhibitor

KW - Term vasodilator therapy

KW - Chronic volume overload

KW - Asymptomatic patients

KW - Mitral regurgitation

KW - Myocardial infarction

KW - Valve regurgitation

KW - Left ventricle

KW - Insufficiecy

KW - Nifedipine

U2 - 10.1016/j.jacc.2011.07.043

DO - 10.1016/j.jacc.2011.07.043

M1 - Article

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 20

VL - 58

SP - 2084

EP - 2091

ER -

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