Withdrawing renin-angiotensin inhibitors/angiotensin receptor-neprilysin inhibitors and mineralocorticoid receptor antagonists tied to higher one-year mortality, morbidity
By Lori Solomon HealthDay Reporter
WEDNESDAY, March 26, 2025 (HealthDay News) — In patients with heart failure with improved ejection fraction (EF), pharmacological therapy is rarely withdrawn, according to a study published online March 17 in Circulation.
Christian Basile, M.D., from the Karolinska Institutet in Stockholm, and colleagues assessed rates, patient profiles, and associations with morbidity/mortality of renin-angiotensin inhibitors (RASi), angiotensin receptor-neprilysin inhibitors (ARNi), beta-blockers (BBL), and mineralocorticoid receptor antagonist (MRA) withdrawal in patients with heart failure with improved EF. The analysis included 8,728 patients with heart failure with improved EF (first recorded EF <40 percent and a later EF ≥40 percent).
The researchers found that the withdrawal rates at the time of the improved EF registration were 4.4 percent for RASi/ARNi, 3.3 percent for BBL, and 17.2 percent for MRA. Lower use of other heart failure medications, higher EF at the later EF registration, and a longer time between the two EF assessments were predictors of withdrawal. Withdrawal was independently associated with a higher risk for cardiovascular mortality/hospitalization at one year for heart failure by 38 percent for RASi/ARNi and 36 percent for MRA after weighting, but there was no association for BBL. There was an association with a higher risk for the primary outcome in the subgroup of patients withdrawn from BBL with an improved EF of 40 to 49 percent versus ≥50 percent.
“These results are hypothesis-generating and highlight the need for randomized controlled trials testing BBL withdrawal in patients with heart failure with improved EF,” the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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