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Nonadherence with ACE inhibitors is common and can be detected in clinical practice by routine serum ACE activity
A D Struthers1, G Anderson, R J MacFadyen
1Departments of Clinical Pharmacology and Therapeutics, Ninewells Hospital, Dundee, DD1 9SY, UK.
Insights
Serum angiotensin-converting enzyme (ACE) activity can identify nonadherence to ACE inhibitor treatment in chronic heart failure (CHF) patients. This simple test helps target adherence strategies for better CHF management.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Diagnostics
Background:
- ACE inhibitors are crucial for managing chronic heart failure (CHF).
- Patient adherence to prescribed medication is vital for treatment efficacy in CHF.
- Assessing adherence in routine clinical practice can be challenging.
Purpose of the Study:
- To evaluate if serum angiotensin-converting enzyme (ACE) activity accurately reflects patient adherence to ACE inhibitor therapy in CHF.
- To determine the utility of serum ACE levels as a biomarker for nonadherence.
Main Methods:
- Serum ACE activity was measured in 73 CHF patients attending a heart failure clinic.
- Patient adherence to ACE inhibitors was assessed by tracking prescription redemption at community pharmacies.
- Serum ACE levels were correlated with adherence data.
Main Results:
- A significant proportion of CHF patients showed suboptimal adherence (18% <70%, 34% <85%, 58% <100%).
- Serum ACE activity >12 U/L predicted <100% adherence with 91% accuracy.
- Serum ACE activity <6.5 U/L predicted >85% adherence with 81% accuracy.
Conclusions:
- Nonadherence to ACE inhibitor treatment is common in CHF patients.
- Serum ACE activity is a simple, inexpensive tool to identify nonadherent patients.
- Targeted adherence interventions can be implemented based on serum ACE levels, though further research is needed.
Abstract:
Our objective was to assess whether serum angiotensin-converting enzyme (ACE) activity during routine clinical practice accurately reflects patient adherence to ACE inhibitor treatment in chronic heart failure (CHF). During 1994-95, ACE was measured in 73 CHF patients who were routinely attending the heart failure clinic at Ninewells Hospital. At the same time, the Medicines Monitoring Unit collected data on whether and when prescriptions for ACE inhibitors were redeemed at community pharmacies, which enabled each patient's adherence over a prolonged period to be assessed. We then correlated whether an elevation in serum ACE was associated with poor adherence with ACE inhibitor treatment. In total, 18% of CHF patients appeared to exhibit less than 70% adherence with their ACE inhibitor treatment, with 34% exhibiting less than 85%adherence and 58% exhibiting less than 100% adherence. A serum ACE activity of more than 12 U/L gave 91% positive predictive accuracy that the patient was less than 100% adherent with his or her ACE inhibitor treatment. At the other extreme, a serum ACE less than 6.5 U/L gave 81% positive predictive accuracy that the patient was more than 85% adherent with ACE inhibitor treatment. Nonadherence with ACE inhibitor treatment, therefore, was found to be common in patients with CHF. The simple, inexpensive test of serum ACE activity can be used in CHF patients to identify many, although not all, nonadherent patients so that adherence-enhancing strategies can be targeted toward them. Further work is clearly required to explore the precise clinical utility of this promising test. (c)2001 by CHF, Inc.