Document Detail

Survival benefits of angiotensin-converting enzyme inhibitors in older heart failure patients with perceived contraindications.
MedLine Citation:
PMID:  12366619     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To determine the association between angiotensin-converting enzyme (ACE) inhibitor therapy and survival of older heart failure patients with conditions perceived by physicians as contraindications to ACE inhibitors. SETTING: Hospital. DESIGN: Retrospective follow-up study. PARTICIPANTS: Hospitalized older heart failure patients with systolic blood pressure of 90 mmHg or less, serum creatinine of 2.5 mg/dL or more, serum potassium of 5.5 mmol/L or more, or severe aortic stenosis. MEASUREMENTS: One-year postdischarge mortality (with and without adjustment for various patient and care characteristics). Logistic regression analyses were used to estimate the effect of the perceived contraindications on subsequent use of ACE inhibitors. Using Cox proportional hazards models, crude and adjusted hazard ratios (HRs) of 1-year mortality with 95% confidence intervals (CIs) were estimated for patients discharged on ACE inhibitors and compared with those without. HRs were estimated for all patients and were repeated after stratifying patients based on the presence of perceived contraindications to ACE inhibitor use. RESULTS: Of the 295 subjects, 52 (18%) had conditions perceived as contraindications, 186 (63%) received ACE inhibitors, and 107 (40%) died within 1 year of discharge. Presence of a perceived contraindication was independently associated with underutilization of ACE inhibitors on discharge (adjusted OR = 0.35, 95% CI = 0.17-0.71). ACE inhibitor prescription at discharge was associated with lower 1-year mortality overall (HR = 0.58, 95% CI = 0.40-0.85) and for the groups of patients with (HR = 0.34, 95% CI = 0.14-0.81) and without (HR = 0.66, 95% CI = 0.42-1.02) perceived contraindications. CONCLUSIONS: ACE inhibitor use was associated with a significant survival benefit in this cohort of hospitalized older heart failure patients with perceived contraindications.
Ali Ahmed; Catarina I Kiefe; Richard M Allman; Richard V Sims; James F DeLong
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American Geriatrics Society     Volume:  50     ISSN:  0002-8614     ISO Abbreviation:  J Am Geriatr Soc     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-10-07     Completed Date:  2002-12-19     Revised Date:  2008-03-10    
Medline Journal Info:
Nlm Unique ID:  7503062     Medline TA:  J Am Geriatr Soc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1659-66     Citation Subset:  IM    
Division of Gerontology and Geriatric Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, USA.
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MeSH Terms
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors / contraindications,  therapeutic use*
Follow-Up Studies
Heart Failure / drug therapy*,  mortality
Patient Discharge / statistics & numerical data
Proportional Hazards Models
Retrospective Studies
Survival Analysis
Survival Rate
Treatment Outcome
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors

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