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Angiotensin-converting enzyme inhibitor dosages in elderly patients with heart failure
Y T Chen1, Y Wang, M J Radford
1Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8025, USA.
Insights
Elderly heart failure patients prescribed higher doses of angiotensin-converting enzyme (ACE) inhibitors at discharge had lower 1-year mortality. Most patients received guideline-consistent ACE inhibitor doses.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Elderly patients with heart failure often receive suboptimal medication dosages.
- Angiotensin-converting enzyme (ACE) inhibitors are crucial for heart failure management.
- Understanding ACE inhibitor dosing at discharge is vital for optimizing patient outcomes.
Purpose of the Study:
- To examine angiotensin-converting enzyme (ACE) inhibitor dosages in elderly heart failure patients at hospital discharge.
- To identify factors influencing ACE inhibitor dosing levels.
- To assess the association between ACE inhibitor dosages and 1-year mortality.
Main Methods:
- Retrospective analysis of medical records from 18 Connecticut hospitals.
- Data collection included demographics, procedures, and medications.
- ACE inhibitor dosages were categorized as target, subtarget, or low dose based on guidelines and clinical trials.
Main Results:
- 554 elderly patients with heart failure and systolic dysfunction were analyzed.
- 19% received target doses, 63% subtarget doses, and 18% low doses of ACE inhibitors.
- Both subtarget and target ACE inhibitor doses were linked to significantly lower 1-year mortality compared to low doses.
Conclusions:
- The majority of elderly heart failure patients (82%) were discharged on guideline-consistent ACE inhibitor doses.
- A dose-response relationship was observed, with higher ACE inhibitor doses correlating with reduced mortality.
- Further research is needed to confirm the causal link between higher ACE inhibitor doses and improved survival.
Background:
We sought to describe the dosages of angiotensin-converting enzyme (ACE) inhibitor prescribed to elderly patients with heart failure at hospital discharge, the factors associated with dosing level, and the association of these dosages with 1-year outcomes.
Methods:
Demographic, procedural, and medication data were collected retrospectively from medical records at 18 Connecticut hospitals. Information on mortality and readmission was obtained from the Health Care Financing Administration administrative databases. Dosages of ACE inhibitor were grouped into 3 categories: dosages recommended in practice guidelines or higher (target dose), dosages used in clinical trials but lower than guideline recommendations (subtarget dose), and dosages lower than those used in clinical trials (low dose).
Results:
A total of 554 patients, 65 years old or less with confirmed heart failure and systolic dysfunction, were prescribed an ACE inhibitor at discharge. Target, subtarget, and low doses were given in 19%, 63%, and 18% of the patients, respectively. Few demographic or clinical factors were related to lower dosages. Both subtarget and target doses of ACE inhibitors were associated with a significantly lower adjusted 1-year mortality (relative risk 0.67, P =.04; relative risk 0.51, P =.02, respectively) compared with low doses of ACE inhibitors.
Conclusions:
In a representative elderly cohort of patients with heart failure with systolic dysfunction, the majority (82%) were discharged on doses of ACE inhibitors consistent with those used in clinical trials. We observed a dose-response relationship between higher doses and lower mortality. Future studies will need to determine whether this association is causal.