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ACE inhibitor use and mortality reduction: do controlled trial results equal clinical practice?
Charles P Schade1, Karen L Hannah, Gary Rezek
1West Virginia Medical Institute, Charleston, USA.
The West Virginia Medical Journal
|May 19, 2006
Summary
Angiotensin converting enzyme inhibitors (ACEIs) significantly reduce one-year mortality in heart failure patients. Despite proven benefits, ACEI prescription rates in West Virginia were not increasing, highlighting a gap in care.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Randomized trials demonstrate that Angiotensin Converting Enzyme Inhibitors (ACEIs) improve outcomes in heart failure.
- Recent data indicate a stagnation in ACEI prescription rates among West Virginia Medicare beneficiaries with heart failure.
Purpose of the Study:
- To investigate the association between ACEI use and mortality in heart failure patients in West Virginia.
- To assess the impact of ACEI discharge prescriptions on one-year mortality.
Main Methods:
- Retrospective analysis of 5,144 heart failure patients discharged from 44 acute care hospitals between 2000-2001.
- Data linkage with beneficiary records to determine one-year mortality post-discharge.
- Logistic regression analysis to evaluate the effect of ACEI prescription on mortality, excluding patients on Angiotensin Receptor Blockers (ARBs).
Main Results:
- Of 863 eligible patients, 716 (83%) were discharged on an ACEI.
- Discharge on an ACEI was significantly associated with a reduction in one-year mortality (P = .0009).
- ACEI use was associated with approximately a one-third reduction in mortality for heart failure patients.
Conclusions:
- Prescribing ACEIs at discharge is associated with improved survival in heart failure patients.
- Despite evidence-based recommendations, adherence to ACEI prescribing guidelines may be suboptimal.
- Further interventions are needed to increase ACEI utilization in heart failure management.
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