Interaction between baseline and early worsening of renal function and efficacy of renin-angiotensin-aldosterone systemblockade in patients with heart failure

Insights from the Val-HeFT study

Anastasia Lesogor, Jay N. Cohn, Roberto Latini, Gianni Tognoni, Henry Krum, Barry Massie, Andrew Zalewski, Albert Kandra, Tsushung A. Hua, Claudio Gimpelewicz

Research output: Contribution to journalArticle

34 Citations (Scopus)

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 2-4 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. 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 groupswas also significant (P = 0.0002;HR0.76, 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 differencewas 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.

Original languageEnglish (US)
Pages (from-to)1236-1244
Number of pages9
JournalEuropean Journal of Heart Failure
Volume15
Issue number11
DOIs
StatePublished - Dec 16 2013

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Valsartan
Angiotensins
Aldosterone
Renin
Heart Failure
Kidney
Glomerular Filtration Rate
Confidence Intervals
Hospitalization
Angiotensin-Converting Enzyme Inhibitors
Placebos
Renin-Angiotensin System
Random Allocation

Keywords

  • Egfr
  • Ewrf
  • Heart failure
  • Prognosis
  • Valsartan

Cite this

Interaction between baseline and early worsening of renal function and efficacy of renin-angiotensin-aldosterone systemblockade in patients with heart failure : Insights from the Val-HeFT study. / Lesogor, Anastasia; Cohn, Jay N.; Latini, Roberto; Tognoni, Gianni; Krum, Henry; Massie, Barry; Zalewski, Andrew; Kandra, Albert; Hua, Tsushung A.; Gimpelewicz, Claudio.

In: European Journal of Heart Failure, Vol. 15, No. 11, 16.12.2013, p. 1236-1244.

Research output: Contribution to journalArticle

Lesogor, Anastasia ; Cohn, Jay N. ; Latini, Roberto ; Tognoni, Gianni ; Krum, Henry ; Massie, Barry ; Zalewski, Andrew ; Kandra, Albert ; Hua, Tsushung A. ; Gimpelewicz, Claudio. / Interaction between baseline and early worsening of renal function and efficacy of renin-angiotensin-aldosterone systemblockade in patients with heart failure : Insights from the Val-HeFT study. In: European Journal of Heart Failure. 2013 ; Vol. 15, No. 11. pp. 1236-1244.
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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 2-4 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. 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 groupswas also significant (P = 0.0002;HR0.76, 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 differencewas 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.",
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author = "Anastasia Lesogor and Cohn, {Jay N.} and Roberto Latini and Gianni Tognoni and Henry Krum and Barry Massie and Andrew Zalewski and Albert Kandra and Hua, {Tsushung A.} and Claudio Gimpelewicz",
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T1 - Interaction between baseline and early worsening of renal function and efficacy of renin-angiotensin-aldosterone systemblockade in patients with heart failure

T2 - 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

PY - 2013/12/16

Y1 - 2013/12/16

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 2-4 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. 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 groupswas also significant (P = 0.0002;HR0.76, 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 differencewas 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.

AB - 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 2-4 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. 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 groupswas also significant (P = 0.0002;HR0.76, 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 differencewas 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.

KW - Egfr

KW - Ewrf

KW - Heart failure

KW - Prognosis

KW - Valsartan

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