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Adverse Events After Initiating Angiotensin-Converting Enzyme Inhibitor/Angiotensin II Receptor Blocker Therapy in Individuals with Heart Failure and Multimorbidity

  • Mayra Tisminetzky
    Correspondence
    Requests for reprints should be addressed to Mayra Tisminetzky, MD, PhD, Division of Geriatric Medicine, University of Massachusetts Chan Medical School, 365 Plantation Street Office Suite 100, Worcester, MA, 01605.
    Affiliations
    Division of Health Systems Science, Department of Medicine, Chan Medical School, University of Massachusetts, Worcester

    Division of Geriatric Medicine, Department of Medicine, Chan Medical School, University of Massachusetts, Worcester

    Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester
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  • Jerry H. Gurwitz
    Affiliations
    Division of Health Systems Science, Department of Medicine, Chan Medical School, University of Massachusetts, Worcester

    Division of Geriatric Medicine, Department of Medicine, Chan Medical School, University of Massachusetts, Worcester

    Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester
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  • Grace Tabada
    Affiliations
    Division of Research, Kaiser Permanente Northern California, Oakland, Calif
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  • Kristi Reynolds
    Affiliations
    Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, Calif

    Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
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  • Stephen P. Fortmann
    Affiliations
    Center for Health Research, Kaiser Permanente Northwest, Portland Ore
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  • Elisha Garcia
    Affiliations
    Division of Health Systems Science, Department of Medicine, Chan Medical School, University of Massachusetts, Worcester
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  • Thu Pham
    Affiliations
    Division of Health Systems Science, Department of Medicine, Chan Medical School, University of Massachusetts, Worcester
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  • Robert Goldberg
    Affiliations
    Division of Health Systems Science, Department of Medicine, Chan Medical School, University of Massachusetts, Worcester

    Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester
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  • Alan S. Go
    Affiliations
    Division of Research, Kaiser Permanente Northern California, Oakland, Calif

    Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif

    Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco

    Department of Medicine, Stanford University, Stanford, Calif
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Published:September 01, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.08.010

      Abstract

      Background

      Current clinical practice guidelines recommend routine kidney function and serum potassium testing within 30 days of initiating angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) therapy. However, evidence is lacking on whether routine follow-up testing reduces therapy-related adverse events in adults with heart failure and if multimorbidity influences the association between laboratory testing and these adverse events.

      Methods

      We conducted a retrospective cohort study among adults with heart failure from 4 US integrated health care delivery systems. Multimorbidity was defined using counts of chronic conditions. Patients with outpatient serum creatinine and potassium tests in the 30 days after starting ACEI or ARB therapy were matched 1:1 to patients without follow-up tests. We evaluated the association of follow-up testing with 30-day all-cause mortality and hospitalization with acute kidney injury or hyperkalemia using Cox regression.

      Results

      We identified 3629 matched adults with heart failure initiating ACEI or ARB therapy between January 1, 2005, and December 31, 2012. Follow-up testing was not significantly associated with 30-day all-cause mortality (adjusted hazard ratio [aHR] 0.45, 95% confidence interval [CI] 0.14; 1.39) and hospitalization with hyperkalemia (aHR 0.73, 95% CI, 0.33; 1.61). However, follow-up testing was significantly associated with hospitalization with acute kidney injury (aHR, 1.40, 95% CI, 1.01; 1.94). Interaction between multimorbidity burden and follow-up testing was not statistically significant in any of the outcome models examined.

      Conclusions

      Routine laboratory monitoring after ACEI or ARB therapy initiation was not associated with risk of 30-day all-cause mortality or hospitalization with hyperkalemia across the spectrum of multimorbidity burden in a cohort of patients with heart failure.

      Keywords

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