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Patterns of prescribing ACE inhibitors after myocardial infarction
A B Luzier1, A Navsarikar, M F Wilson
1Department of Pharmacy Practice, State University of New York at Buffalo School of Pharmacy, 14260-1200, USA.
Insights
Physicians underprescribe angiotensin-converting enzyme (ACE) inhibitors after myocardial infarction. Recommended dosages were given to only 11% of patients, highlighting a gap in optimal cardiovascular care.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Angiotensin-converting enzyme (ACE) inhibitors are crucial for managing patients post-myocardial infarction (MI).
- Optimal prescription patterns are essential for improving patient outcomes and reducing cardiovascular events.
Purpose of the Study:
- To evaluate physician prescribing patterns of ACE inhibitors in MI patients.
- To assess ACE inhibitor dosage and stratification by left ventricular function.
Main Methods:
- Retrospective review of drug therapy at discharge for 534 MI patients.
- Analysis of ACE inhibitor prescription rates and dosages.
- Stratification based on ejection fraction (EF) <40% versus EF >=40%.
Main Results:
- Only 34% of MI patients were discharged on an ACE inhibitor.
- Of those on ACE inhibitors, only 11% received recommended dosages.
- ACE inhibitors were more frequently prescribed in patients with EF <40% (54%) compared to those with EF >=40% (28%, p<0.05).
Conclusions:
- ACE inhibitors are significantly underprescribed in the post-MI population.
- A notable gap exists between clinical research evidence and actual clinical practice.
- Interventions are needed to promote optimal medical management and improve ACE inhibitor utilization after MI.
Abstract:
We attempted to determine physician prescribing patterns of angiotensin-converting enzyme (ACE) inhibitors in patients who experienced a myocardial infarction, stratified by left ventricular function. We retrospectively reviewed drug therapy at discharge in 534 patients to assess prescription of ACE inhibitor therapy, including dosage. Thirty-four percent of patients were discharged taking an ACE inhibitor, of whom only 11% received recommended dosages. The drugs were prescribed more often for patients who had an ejection fraction below 40% than for those with an ejection fraction of 40% or above (54% vs 28%, p<0.05). We conclude that ACE inhibitors are underprescribed for patients who experienced a myocardial infarction, illustrating the gap between clinical research and clinical practice, and the need for programs to ensure optimal medical management.