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Interaction between baseline and early worsening of renal function and efficacy of renin-angiotensin-aldosterone system blockade in patients with heart failure: insights from the Val-HeFT study.
Eur J Heart Fail. 2013 Nov; 15(11):1236-44.EJ

Abstract

AIMS

We evaluated the effect of (dual) renin-angiotensin-aldosterone system (RAAS) blockade with valsartan and an ACE inhibitor [92.7% of patients were treated with an ACE inhibitor in the Valsartan in Heart Failure Trial (Val-HeFT)] in patients with NYHA class II-IV heart failure (HF) and reduced EF on cardiovascular (CV) death and HF hospitalization by subgroups and by presence of early worsening of renal function (EWRF) and according to baseline estimated glomerular filtration rate (eGFR).

METHODS AND RESULTS

We analysed the data from 5010 patients enrolled in the Val-HeFT study. A total of 2346 (46.8%) patients had baseline renal impairment (i.e. baseline eGFR <60 mL/min/1.73 m(2)). Further, 425 patients (8.6%) had EWRF (i.e. eGFR decrease >20% within 1 month after randomization), whereas 4503 patients (91.4%) had ≤20% decline in eGFR. Overall, the difference between valsartan and placebo on the composite endpoint of CV death and HF hospitalization was significant [P = 0.0005; hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.75-0.92)]. In patients with baseline renal impairment, the difference between the treatment groups was also significant (P = 0.0002; HR 0.76, 95% CI 0.66-0.88). Patients with EWRF had higher risk of CV death and HF hospitalization vs. those without ERWF (P < 0.0001; HR 1.44, 95% CI 1.21-1.71), and within the EWRF group a significant difference was also observed between valsartan and placebo (P = 0.0086; HR 0.63, 95% CI 0.45-0.89). However, the interaction between treatment and eGFR at Month 1 was not significant (P = 0.1160).

CONCLUSION

Benefits were maintained in patients with renal dysfunction at baseline and those who experienced EWRF.

Authors+Show Affiliations

Novartis Pharma AG, Basel, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23787721

Citation

Lesogor, Anastasia, et al. "Interaction Between Baseline and Early Worsening of Renal Function and Efficacy of Renin-angiotensin-aldosterone System Blockade in Patients With Heart Failure: Insights From the Val-HeFT Study." European Journal of Heart Failure, vol. 15, no. 11, 2013, pp. 1236-44.
Lesogor A, Cohn JN, Latini R, et al. Interaction between baseline and early worsening of renal function and efficacy of renin-angiotensin-aldosterone system blockade in patients with heart failure: insights from the Val-HeFT study. Eur J Heart Fail. 2013;15(11):1236-44.
Lesogor, A., Cohn, J. N., Latini, R., Tognoni, G., Krum, H., Massie, B., Zalewski, A., Kandra, A., Hua, T. A., & Gimpelewicz, C. (2013). Interaction between baseline and early worsening of renal function and efficacy of renin-angiotensin-aldosterone system blockade in patients with heart failure: insights from the Val-HeFT study. European Journal of Heart Failure, 15(11), 1236-44. https://doi.org/10.1093/eurjhf/hft089
Lesogor A, et al. Interaction Between Baseline and Early Worsening of Renal Function and Efficacy of Renin-angiotensin-aldosterone System Blockade in Patients With Heart Failure: Insights From the Val-HeFT Study. Eur J Heart Fail. 2013;15(11):1236-44. PubMed PMID: 23787721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interaction between baseline and early worsening of renal function and efficacy of renin-angiotensin-aldosterone system blockade in patients with heart failure: insights from the Val-HeFT study. AU - Lesogor,Anastasia, AU - Cohn,Jay N, AU - Latini,Roberto, AU - Tognoni,Gianni, AU - Krum,Henry, AU - Massie,Barry, AU - Zalewski,Andrew, AU - Kandra,Albert, AU - Hua,Tsushung A, AU - Gimpelewicz,Claudio, Y1 - 2013/06/19/ PY - 2013/6/22/entrez PY - 2013/6/22/pubmed PY - 2014/6/11/medline KW - EWRF KW - Heart failure KW - Prognosis KW - Valsartan KW - eGFR SP - 1236 EP - 44 JF - European journal of heart failure JO - Eur J Heart Fail VL - 15 IS - 11 N2 - AIMS: We evaluated the effect of (dual) renin-angiotensin-aldosterone system (RAAS) blockade with valsartan and an ACE inhibitor [92.7% of patients were treated with an ACE inhibitor in the Valsartan in Heart Failure Trial (Val-HeFT)] in patients with NYHA class II-IV heart failure (HF) and reduced EF on cardiovascular (CV) death and HF hospitalization by subgroups and by presence of early worsening of renal function (EWRF) and according to baseline estimated glomerular filtration rate (eGFR). METHODS AND RESULTS: We analysed the data from 5010 patients enrolled in the Val-HeFT study. A total of 2346 (46.8%) patients had baseline renal impairment (i.e. baseline eGFR <60 mL/min/1.73 m(2)). Further, 425 patients (8.6%) had EWRF (i.e. eGFR decrease >20% within 1 month after randomization), whereas 4503 patients (91.4%) had ≤20% decline in eGFR. Overall, the difference between valsartan and placebo on the composite endpoint of CV death and HF hospitalization was significant [P = 0.0005; hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.75-0.92)]. In patients with baseline renal impairment, the difference between the treatment groups was also significant (P = 0.0002; HR 0.76, 95% CI 0.66-0.88). Patients with EWRF had higher risk of CV death and HF hospitalization vs. those without ERWF (P < 0.0001; HR 1.44, 95% CI 1.21-1.71), and within the EWRF group a significant difference was also observed between valsartan and placebo (P = 0.0086; HR 0.63, 95% CI 0.45-0.89). However, the interaction between treatment and eGFR at Month 1 was not significant (P = 0.1160). CONCLUSION: Benefits were maintained in patients with renal dysfunction at baseline and those who experienced EWRF. SN - 1879-0844 UR - https://www.unboundmedicine.com/medline/citation/23787721/Interaction_between_baseline_and_early_worsening_of_renal_function_and_efficacy_of_renin_angiotensin_aldosterone_system_blockade_in_patients_with_heart_failure:_insights_from_the_Val_HeFT_study_ L2 - https://doi.org/10.1093/eurjhf/hft089 DB - PRIME DP - Unbound Medicine ER -