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Determinants of angiotensin-converting enzyme inhibitor prescription in severe heart failure with left ventricular

M Echemann1, F Zannad, S Briançon

  • 1Service d'Epidémiologie et d'Evaluation Cliniques, Hôpital Marin, France.

American Heart Journal
|March 31, 2000
PubMed

Insights

Angiotensin-converting enzyme (ACE) inhibitors are underused in severe heart failure. Elderly patients with renal impairment often receive suboptimal ACE inhibitor doses, highlighting the need for better adherence to treatment guidelines.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Angiotensin-converting enzyme (ACE) inhibitors improve outcomes in heart failure with left ventricular systolic dysfunction.
  • Current clinical practice shows underutilization and suboptimal dosing of ACE inhibitors.
  • Severe long-term congestive heart failure (CHF) management requires optimal ACE inhibitor therapy.

Purpose of the Study:

  • Identify factors associated with ACE inhibitor nonprescription in severe CHF.
  • Determine factors linked to sub-recommended ACE inhibitor dosing in severe CHF.
  • Improve adherence to ACE inhibitor treatment guidelines for heart failure.

Main Methods:

  • Epidemiologic observational study (EPICAL) involving 417 severe CHF patients.
  • Multivariate logistic regression analysis to identify associated factors.
  • Analysis of social, demographic, laboratory, clinical, and therapeutic variables.

Main Results:

  • ACE inhibitors were prescribed to 75% of patients; 38% received lower-than-recommended doses.
  • Nonprescription associated with age >65, renal impairment, nonsinus rhythm, and potassium-sparing diuretics.
  • Renal impairment, especially in elderly patients, was the primary factor for suboptimal dosing.

Conclusions:

  • Optimal use of ACE inhibitor therapy in severe CHF is crucial.
  • Physicians must uniformly apply CHF treatment guidelines.
  • Addressing factors leading to underprescription and suboptimal dosing is necessary.
Abstract

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