Improved mortality associated with ACE-I and Beta Blocker Treatment in Herat Failure with preserved ejection fraction: An Exploratory Analysis of the biomarkers in acute heart failure (BACH) trial

Background: There is limited evidence on the optimal management of preserved ejection fraction (EF) heart failure (HF). We compared outcomes of patients hospitalized with acute HF based on their systolic function and discharge medications. Methods: This study was an exploratory analysis of the Biomarkers in ACute Heart Failure (BACH) trial, a multi-center study assessing novel biomarkers in dyspneic patients presenting to emergency department. Enrolled patients who were admitted to the hospital were followed for 90-days for all-cause mortality. Results: Of 1641 enrolled patients, 429 had a primary diagnosis of HF and EF data, and 50 of these patients died during follow-up. 162 of these patients had preserved EF with an EF 50%. In both reduced and preserved EF groups, patients discharged on either ACE-I or beta blocker had better survival (see figure containing Kaplan-Meier survival curves). Survival benefit was greatest in patients discharged on dual therapy, and this persisted after adjusting for age, gender, history of HF, diabetes and chronic renal insufficiency. Conclusions: After hospitalization for acute HF, discharge on ACE-I and beta blockers is associated with substantial survival benefit in patients with preserved ejection fraction. This strongly suggests a new therapeutic approach for acute HF patients with preserved EF