Evidence map›Paper›PMID 39551174›Full record

ArticleThe American journal of medicine2025

Lower Risk of Death and Kidney Failure Associated with Higher Target (vs Below-Target) Doses of RAS Inhibitors in Octogenarians with HFrEF.

Mo-Kyung Sin, Richard M Allman, Charles Faselis, Wilbert S Aronow, Cynthia J Brown, Phillip H Lam, Wen-Chih Wu, Qing Zeng-Treitler, Samir S Patel, Venkatesh K Raman and 6 more

Abstract read
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In one paragraph

Article in The American journal of medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Mo-Kyung SinCollege of Nursing, Seattle University, Wash.
Richard M AllmanDepartment of Medicine, George Washington University, Washington, DC; Department of Medicine, University of Alabama at Birmingham; Department of Medicine, Wake Forest University, Winston-Salem, NC.
Charles FaselisDepartment of Medicine, George Washington University, Washington, DC; Department of Medicine, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, Uniformed Services University, Washington, DC.
Wilbert S AronowDepartment of Medicine, Westchester Medical Center, Valhalla, NY; Department of Medicine, New York Medical College, Valhalla, NY.
Cynthia J BrownDepartment of Medicine, Louisiana State University, New Orleans.
Phillip H LamDepartment of Medicine, Georgetown University, Washington, DC; Department of Medicine, Medstar Washington Hospital Center, Washington, DC.
Wen-Chih WuDepartment of Medicine, Veterans Affairs Medical Center, Providence, RI; Department of Medicine, Brown University, Providence, RI.
Qing Zeng-TreitlerDepartment of Medicine, George Washington University, Washington, DC; Department of Medicine, Veterans Affairs Medical Center, Washington, DC.
Samir S PatelDepartment of Medicine, George Washington University, Washington, DC; Department of Medicine, Veterans Affairs Medical Center, Washington, DC.
Venkatesh K RamanDepartment of Medicine, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC.
Sijian ZhangDepartment of Medicine, Veterans Affairs Medical Center, Washington, DC.
Helen M SheriffDepartment of Medicine, George Washington University, Washington, DC; Department of Medicine, Veterans Affairs Medical Center, Washington, DC.
Charity J MorganDepartment of Medicine, Veterans Affairs Medical Center, Washington, DC; Department of Biostatistics, University of Alabama at Birmingham.
Paul A HeidenreichDepartment of Medicine, Veterans Affairs Palo Alto Health Care System, Calif; Department of Medicine, Stanford University, Calif.
Gregg C FonarowDepartment of Medicine, University of California, Los Angeles.
Ali AhmedDepartment of Medicine, George Washington University, Washington, DC; Department of Medicine, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, Georgetown University, Washington, DC. Electronic address: ali.ahmed@va.gov.

Funding

Improving Outcomes in Veterans with Heart Failure and Chronic Kidney DiseaseI01HX002422 · VA · U.S. DEPT/VETS AFFAIRS MEDICAL CENTER · PI AHMED, ALI, WU, WEN-CHIH · 2019 to 2025
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HSRD VA I01 HX002422HSRD VA SDR 02-237
6 · The paper itself

Abstract

backgroundRenin-angiotensin system (RAS) inhibitors at higher target doses reduce the risk of death in patients with heart failure with reduced ejection fraction (HFrEF). Less is known about their effectiveness in octogenarians, the examination of which was the objective of this study.

methodsOf the 32,964 veterans ≥ 80 years with HFrEF (ejection fraction ≤ 40%) receiving RAS inhibitors, 6655 received them at target doses. Using propensity scores for the receipts of target-dose, calculated for each of the 32,964 patients, we assembled a matched cohort of 13,284 patients balanced on 66 baseline characteristics. Hazard ratios (95% CI) for 5-year mortality and kidney failure associated with target (vs below-target) dose RAS inhibitor use were estimated in the matched cohort. Kidney failure was defined as receipt of kidney replacement therapy or estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73m

resultsPatients had mean (±SD) age 84.5 (±3.4) years, EF 31.3 (±8.2) %, and eGFR 58.5 (±18.2) mL/min/1.73m

conclusionsThese findings provide evidence that in octogenarians with HFrEF, the use of RAS inhibitors at higher target (vs below-target) doses is associated with lower risks of death and kidney failure.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsHeart FailureRenal InsufficiencyRenin-Angiotensin SystemAged, 80 and overFemaleGlomerular Filtration RateHumansMaleStroke VolumeAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsDeathHFrEFKidney failureOctogenariansRAS inhibitorsTarget dose

Identifiers

PMID39551174
PMCPMC12844227

What Socratic holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.