Document Detail


Underutilization and clinical benefits of angiotensin-converting enzyme inhibitors in patients with asymptomatic left ventricular dysfunction.
MedLine Citation:
PMID:  10980216     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Despite evidence of therapeutic benefit of angiotensin-converting enzyme (ACE) inhibitors for congestive heart failure and asymptomatic left ventricular (LV) dysfunction, recent studies suggest that in heart failure patients, rates of ACE inhibitor usage in clinical practice remain low. In this study, the medical records of 107 patients with documented LV dysfunction were investigated for patterns of ACE inhibitor usage; 6-month and 1-year outcomes and event rates were evaluated. At index admission, 48% patients did not receive ACE inhibitor treatment, 32% were initiated on treatment, 19% continued on a prior regimen, and 1% were discontinued. Patients seen by a cardiologist were more likely to receive ACE inhibitor treatment (53% vs 35%, p = 0. 172), as were patients with histories of hypertension (60% vs 40%, p = 0.044) or myocardial infarction (56% vs 44%, p = 0.221). Significantly shorter hospitalizations (5.9 vs 9.5 days, p = 0.001) were noted for patients with on-going ACE inhibitor treatment compared with those receiving newly initiated treatment or no treatment. At time of hospital discharge, 102 patients were alive. Of 54 patients who received ACE inhibitors, 67% received an insufficient dose. At a 6-month follow-up, of 51 patients on ACE inhibitors, 23% died or were readmitted to hospital compared with 55% of nonusers (p = 0.001). At 1 year, this event rate was 31% among ACE inhibitor users versus 71% among nonusers (p < 0.0001). Bivariate and multivariate analysis revealed absence of ACE inhibitor use as the only significant variable associated with the event rate (p < 0.0011). Thus, about half of patients with asymptomatic LV dysfunction received ACE inhibitors; 2/3 of these did not receive a sufficient dose. ACE inhibitor usage increased with involvement of a cardiologist, presence of coexistent hypertension, or prior myocardial infarction. Ongoing ACE inhibitor therapy was associated with shorter hospitalizations and fewer hospital readmissions or deaths.
Authors:
M Kermani; A Dua; A H Gradman
Related Documents :
14564146 - Switching between beta blockers in heart failure patients: rationale and practical cons...
17719466 - Resting heart rate in cardiovascular disease.
22867706 - Twelve-month results of a paclitaxel releasing balloon in patients presenting with in-s...
22557846 - Dronedarone for recurrent ventricular tachycardia: a real alternative?
12849656 - Long-term outcome of patients with silent versus symptomatic ischemia six months after ...
15321736 - M40403 prevents myocardial injury induced by acute hyperglycaemia in perfused rat heart.
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  86     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2000 Sep 
Date Detail:
Created Date:  2000-10-18     Completed Date:  2000-11-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  644-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Western Pennsylvania Hospital, Pittsburgh, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Disease-Free Survival
Drug Utilization / statistics & numerical data
Female
Humans
Length of Stay
Male
Middle Aged
Pennsylvania
Physician's Role
Retrospective Studies
Ventricular Dysfunction, Left / drug therapy*
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Mortality following radiofrequency catheter ablation (from the Pediatric Radiofrequency Ablation Reg...
Next Document:  Effects of spironolactone on heart rate variability and left ventricular systolic function in severe...