Effect of Statin Therapy on One-Year Mortality After Hospitalisation for Acute Heart Failure: Presented at ESC
By Chris Berrie
VIENNA, AUSTRIA -- September 6, 2007 -- Statin therapy is associated with markedly improved survival after hospitalisation for acute heart failure (AHF), according to a prospective, observational, multicentre study presented here at the European Society of Cardiology (ESC).
Furthermore, this protective effect is independent of contemporary treatment with beta blockers, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs), and is particularly pronounced in patients with no coronary artery disease (CAD), the researchers reported.
Coinvestigator Johann P.E. Lassus, MD, Cardiology Trainee, Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland, presented the findings on September 3rd on behalf of the Finnish Acute Heart Failure Study (FINN-AKVA) investigators.
"There has been data on patients with chronic heart failure that statins are beneficial in terms of prognosis and outcomes, but no study has investigated [statins] in acute heart failure," he noted. Therefore, Dr. Lassus and colleagues studied the association of statin use on outcomes in patients with AHF.
The patient cohort consisted of patients hospitalised for AHF (n = 620) who were discharged alive (n = 576). These patients were then categorised according to statin use at discharge, and the primary endpoint was all-cause mortality 1 year after discharge.
Baseline median age and gender distribution was not significantly different between statin users and nonusers, with left ventricular ejection fraction also similar in the two groups, at approximately 45%.
However, there were a series of significant differences between statin users (n = 237) and nonusers (n = 336) at baseline. According to patient medical histories, significance was seen for coronary artery disease (70% vs 43%, respectively; P <.0001), myocardial infarction (36% vs 20%; P <.0001), hypertension (64% vs 48%; P =.0002), diabetes (41% vs 26%; P =.0003), and dyslipidaemia (45% vs 12%; P <.0001).
As well, acute coronary syndrome at admission was significantly higher among statin users (50% vs 16%; P <.0001), although no differences were seen for New York Heart Association class III/IV (77% vs 72%; P =.2) and blood pressure (149/82 vs 148/84 mm Hg).
For the use of the statins themselves, Dr. Lassus said, "This [study] was not restricted to any particular statin, although simvastatin was used in 44% of the patients, and atorvastatin was the next most frequent."
Significantly more statin users were on beta blockers background medication at discharge (90% vs 84%; P =.05), and the same trend was seen for ACEIs/ARBs (81% vs 74%; P =.06). Use of spironolactone (17% vs 21%) and furosemide (88% vs 89%) was the same between statin users and nonusers.
After 1 year of follow-up, 125 patients (22%) had died. However, statin therapy was seen to be significantly associated with improved survival (85% vs 73%; P =.0007).
When stratified according to history of previous heart failure and coronary artery disease and acute coronary syndrome on admission, the 1-year mortalities after hospitalisation for AHF showed a significant benefit (P <.05) of approximately 40% for statin use across the full range of these patient conditions. Of note, the benefits were particularly large (about 80% decrease) for patients with no CAD.
Finally, when the data were adjusted for age, gender, coronary artery disease and other relevant medical history, clinical parameters on admission, and other medication on discharge, statin therapy remained independently associated with a favourable outcome at 1 year, with a hazard ratio of 0.49 (95% CI, 0.30-0.79; P =.004).
"Therefore," said Dr. Lassus, "after hospitalisation for acute heart failure, statin therapy seems to be beneficial in a broad range of acute heart failure conditions, and improves prognosis in terms of mortality at 1 year."
He stressed that this study strongly supports statin use following hospitalisation for AHF, an effect that is also independent of standard contemporary treatments.
"I think that both in chronic heart failure and in acute heart failure it would be interesting to do a real randomised prospective study to see if this is really reproducible in a randomised setting," he added.
Funding for this project was provided by Orion Pharma.
[Presentation title: The Effect of Statin Therapy on One-Year Mortality After Hospitalisation for Acute Heart Failure. Abstract P2597]