Impact of renin‐angiotensin system inhibitors on long‐term clinical outcomes of patients with rheumatic heart disease

AIMS: Rheumatic heart disease (RHD) remains a major global health problem. Renin–angiotensin–aldosterone system inhibitors (RAASi) are commonly administered in the treatment of cardiovascular disease, but its role in RHD patients is still limited. We performed a retrospective study to determine the effect of RAASi on long‐term outcomes for RHD patients. METHODS AND RESULTS: A 1:1 propensity score matching was implemented to balance baseline characteristics between groups RAASi and non‐RAASi. Cox proportional hazards regression model was used to investigate the associations of RAASi with the risks of all‐cause mortality, cardiovascular death (CVD), and cerebrovascular death. Binary logistic regression analysis was used to evaluate the associations of RAASi with the risks of 1, 3, and 5 year heart failure (HF) rehospitalization, new‐onset atrial fibrillation (AF), and new‐onset stroke. A total of 734 RHD patients were enrolled as study participants; nearly half of these participants had combined valve damage (54.4%), worse New York Heart Association functional class status (III and IV, 55.2%), surgical treatment (54.2%), and AF (65.0%). After propensity score matching, 514 RHD patients were finally analysed. RAASi treatment was associated with decreased risks of all‐cause mortality [adjusted hazard ratio (HR) = 0.52, 95% confidence interval (CI): 0.37–0.73, P < 0.001], CVD (adjusted HR = 0.48, 95% CI: 0.30–0.76, P = 0.002), and cerebrovascular death (adjusted HR = 0.22, 95% CI: 0.08–0.60, P = 0.003). Further subgroup analysis showed that RAASi treatment was associated with decreased risks of all‐cause mortality (adjusted HR = 0.50, 95% CI: 0.31–0.79, P = 0.004), CVD (adjusted HR = 0.48, 95% CI: 0.25–0.91, P = 0.025), and cerebrovascular death (adjusted HR = 0.19, 95% CI: 0.05–0.65, P = 0.008) in RHD patients without surgical treatment, and better effect was observed in RHD patients with surgical treatment on the risks of all‐cause mortality (adjusted HR = 0.47, 95% CI: 0.26–0.85, P = 0.012) and CVD (adjusted HR = 0.43, 95% CI: 0.21–0.90, P = 0.024) except cerebrovascular death (adjusted HR = 0.52, 95% CI: 0.08–3.36, P = 0.491). RAASi treatment was associated with decreased HF rehospitalization risk of 1 year [adjusted odds ratio (OR) = 0.38, 95% CI: 0.23–0.61, P < 0.001], 3 year (adjusted OR = 0.43, 95% CI: 0.28–0.68, P < 0.001), and 5 year (adjusted OR = 0.48, 95% CI: 0.30–0.77, P = 0.002) as well as new‐onset AF risk (adjusted OR = 0.38, 95% CI: 0.21–0.68, P = 0.001). RAASi treatment had nothing to do with new‐onset stroke risk (adjusted OR = 0.80, 95% CI: 0.47–1.38, P = 0.428). CONCLUSION: Renin–angiotensin–aldosterone system inhibitor treatment was significantly associated with decreased risks of mortality, HF rehospitalization, and new‐onset AF in RHD patients in median 5.9 year follow‐up.