TITLE

Underutilisation of ACE Inhibitors in Patients with Congestive Heart Failure

AUTHOR(S)
Bungard, T.J.; McAlister, F.A.; Johnson, J.A.; Tsuyuki, R.T.
PUB. DATE
November 2001
SOURCE
Drugs;Nov2001, Vol. 61 Issue 14, p2021
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Congestive heart failure (CHF) is associated with substantial morbidity and mortality, and is the only major cardiovascular disease increasing in prevalence. Despite abundant evidence to support their efficacy and cost-effectiveness, angiotensin-converting enzyme (ACE) inhibitors are sub-optimally used in patients with CHF. This paper reviews the evidence for the sub-optimal use of ACE inhibitors in patients with CHF, the factors contributing to this, and its implications for health systems. A systematic review of all articles assessing practice patterns (specifically the use of ACE inhibitors in CHF) identified by MEDLINE, search of bibliographies, and contact with content experts was undertaken. 37 studies have documented the use of ACE inhibitors in patients with CHF. Studies assessing use among all patients with CHF document 33% to 67% (median 51%) of all patients discharged from hospital and 10% to 36% (median 26%) of community dwelling patients were prescribed ACE inhibitors. Rates of ACE inhibitor use range from 43% to 90% (median of 71%) amongst those discharged from hospital having known systolic dysfunction, and from 67% to 95% (median of 86%) for those monitored in specialty clinics. Moreover, the dosages used in the ‘real world’ are substantially lower than those proven efficacious in randomised, controlled trials, with evaluations reporting only a minority of patients achieving target doses and/or an overall mean dose achieved to be less than one-half of the target dose. Factors predicting the use and optimal dose administration of ACE inhibitors are identified, and include variables relating to the setting (previous hospitalisation, specialty clinic follow-up), the physician (cardiology specialty versus family practitioner or general internist, board certification), the patient (increased severity of symptoms, male, younger), and the drug (lower frequency of administration). In light of the substantial evidence for reductions in morbidity and mortality, clearly, the prescription of ACE inhibitors is sub-optimal. Wide variability in ACE inhibitor use is noted, with higher rates consistently reported among patients having systolic dysfunction confirmed by an objective assessment - an apparent minority of the those having CHF. Optimisation of the prescription of proven efficacious therapies has the potential to confer a substantial reduction in the total cost of care for patients with CHF by reducing hospitalisations and lengths of hospital stays. It is likely that only multifaceted programs targeted toward the population at large will yield benefits to the healthcare system, given the widespread nature of the sub-optimal prescription of therapies proven effective in the management of patients with CHF.
ACCESSION #
5500885

 

Related Articles

  • Success of a P&T policy for use of a second ACE inhibitor before switching to an ARB.  // Formulary;Feb2002, Vol. 37 Issue 2, p97 

    Focuses on the use of ACE inhibitor therapy for treatment of congestive heart failure in Miami, Florida. Development of policy by Miami VA Medical Center's P & T Committee for the use of ACE inhibitors; Association of captopril and enlapril with highest incidence of cough; Use of Angiotensin II...

  • Are Angiotensin-II Antagonists Effective in CHF Treatment? Miller, Karl E. // American Family Physician;10/15/1999, Vol. 60 Issue 6, p1812 

    Presents an abstract of the study `Dose-related beneficial long-term hemodynamic and clinical efficacy of irbesartan in heart failure,' by E. P. Havranek et al., from April 1999 issue of the `Journal of American College Cardiology.'

  • The ABCs of Treating Congestive Heart Failure.  // American Family Physician;9/15/2001, Vol. 64 Issue 6, p936 

    Editorial. Introduces an article which summarized guidelines for treating congestive heart failure caused by systolic dysfunction, which appeared on the September 15, 2001 issue of `American Family Physician.'

  • Effects of ACE inhibitors in congestive heart failures.  // American Family Physician;10/1/1995, Vol. 52 Issue 5, p1506 

    Reports on a study from the May 10, 1995 issue of the `Journal of the American Medical Association,' by Garg and colleagues who reviewed a variety of studies that examined the effect of ACE inhibitors on morbidity and mortality from congestive heart failures. Reduction of deaths and...

  • Effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on hemoglobin levels. Ajmal, Adnan; Gessert, Charles E.; Johnson, Brian P.; Renier, Colleen M.; Palcher, Jeanette A. // BMC Research Notes;2013, Vol. 6 Issue 1, p1 

    Background Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely used in the management of congestive heart failure (CHF), diabetes mellitus (DM) and hypertension (HTN). Use of these agents is reported to cause anemia. Methods We examined the...

  • fosinopril.  // Royal Society of Medicine: Medicines;2002, p257 

    The article presents information on fosinopril. The drug is an ACE inhibitor and acts as a vasodilator. It can be used as an antihypertensive and as a congestive heart failure treatment often when other treatments cannot be used. It is frequently administered in conjunction with other classes of...

  • Angiotensin II Antagonist Had No Survival Benefit over an ACE Inhibitor in Elderly Patients with Congestive Heart Failure but Was Better Tolerated. B., Pitt; P.A., Poole-Wilson; R., Segal; Frishman, William H. // Annals of Internal Medicine;9/18/2001, Vol. 135 Issue 6, p443 

    Compares the efficacy of angiotensin II antagonists and angiotensin converting enzyme (ACE) inhibitors in treating congestive heart failure. Effects of ACE inhibitors on bradykinin levels; Estimation of the average annual rates of all-cause mortality; Elimination of the cough in a patient taking...

  • First-line therapy for CHF. Yacone-Morton, Linda Ann; Hurley, Mary Lou // RN;Feb95, Vol. 58 Issue 2, p38 

    Part I. Looks at the use of diuretics and angiotensin converting enzyme (ACE) inhibitors in treating congestive heart failure (CHF). Factors contributing to CHF; Role of diuretics and ACE inhibitors in reducing stress on the heart; Guidelines from the Agency for Health Care Policy and...

  • Combination treatment recommended for congestive heart failure. SHAW, KENDALL // Drug Store News;10/19/98, Vol. 20 Issue 17, pCP22 

    Reports on the results of a study on the use of a combination of digoxin, a diuretic and an angiotensin-converting enzyme inhibitor to treat congestive heart failure. Safety of the drug combination; Results of the treatment regimen.

  • Cardiovascular safety of non-steroidal anti-inflammatory drugs. Nadesalingam, Kavitha; Kirby, David // British Journal of General Practice;Dec2013, Vol. 63 Issue 617, p632 

    A letter to the editor is presented in response to the article "Drug Safety Project, Vol. 6, issue 11."

Share

Read the Article

Courtesy of NEW JERSEY STATE LIBRARY

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics