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ACE inhibitors and heart failure in hospital: any difference between cardiologists and general physicians?
1MRC Clinical Research Initiative in Heart Failure, University of Glasgow, UK.
Insights
Angiotensin-converting enzyme (ACE) inhibitor use in heart failure patients is suboptimal, with significant underuse and unwarranted non-prescription. Cardiologists prescribe ACE inhibitors more frequently and at higher doses than generalists, potentially impacting patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Discrepancies exist between self-reported and actual use of angiotensin-converting enzyme (ACE) inhibitors.
- Limited data available on the real-world utilization of ACE inhibitors in heart failure patients.
- Understanding prescribing patterns between cardiologists and generalists is crucial for optimizing heart failure management.
Purpose of the Study:
- To assess the utilization of ACE inhibitors in patients with moderate to severe left ventricular systolic dysfunction.
- To investigate differences in ACE inhibitor prescribing patterns between cardiologists and generalists.
- To evaluate the appropriateness of ACE inhibitor prescription and dosage in a teaching hospital setting.
Main Methods:
- Retrospective study of 236 heart failure patients with echocardiographic evidence of moderate/severe left ventricular systolic dysfunction.
- Data collected from the Western Infirmary of Glasgow between April 1, 1996, and October 1, 1996.
- Analysis of ACE inhibitor prescription status, reasons for non-prescription, and dosage compared to major survival studies.
Main Results:
- 66% of patients were prescribed ACE inhibitors; 12% were intolerant, 10% had contraindications, and 12% were not prescribed without contraindication.
- Cardiologists prescribed ACE inhibitors more frequently (77% vs. 53%) and at higher doses compared to generalists (48% vs. 31% in major studies).
- Fewer patients under cardiologist care were never tried on ACE inhibitors (11% vs. 29%), regardless of contraindications.
Conclusions:
- Despite improvements, ACE inhibitor under-utilization in heart failure persists, sometimes without valid clinical reasons.
- Significant differences in ACE inhibitor prescribing practices exist between cardiologists and generalists.
- These prescribing variations may influence patient outcomes and healthcare resource utilization.
Abstract:
Cardiologists and generalists have been reported to diverge in terms of their self-reported use of angiotensin-converting enzyme (ACE) inhibitors, but information on their actual use of ACE inhibitors has been lacking. In order to assess ACE inhibitor use in patients with heart failure in a teaching hospital and any differences between specialties we studied all patients in the Western Infirmary of Glasgow between 1 April and 1 October 1996 with an echocardiogram showing moderate or severe left ventricular systolic dysfunction (n = 236). We found that most patients were on an ACE inhibitor (66%), 12% had been tried but found to be intolerant, 10% had not been tried because of a contraindication, but 12% had not been tried despite no contraindication. Of those on treatment, 58% were on a dose used in a major survival study (38% of all patients). Most patients were treated by a cardiologist (64%). Of these, more were on an ACE inhibitor (77% vs 53%, p < 0.01), fewer had been tried but found intolerant (11% vs 18%), and fewer had never been tried (11% vs 29%, p < 0.01), irrespective of whether they had a contraindication (5% vs 18%, p < 0.01) or not (6% vs 12%). More were on a dose used in a major survival study (48% vs 31%, p < 0.05). We conclude that, despite improvements over time, ACE inhibitors are still under-used, sometimes without good reason. There are also differences in the use of ACE inhibitors between cardiologists and generalists which may affect outcome, and could affect resource utilisation.