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Underutilization of angiotensin converting enzyme inhibitors among heart failure patients

Q Y Lean1, N Shamsuddin, W A Wan Ahmad

  • 1Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.

The Medical Journal of Malaysia
|March 3, 2009
PubMed

Insights

Angiotensin converting enzyme inhibitors (ACEI) are underutilized in heart failure (HF) management. This study found low ACEI use and dosing in hospitalized HF patients, highlighting factors contributing to this underuse.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Established guidelines recommend Angiotensin Converting Enzyme Inhibitors (ACEI) for heart failure (HF) management.
  • Despite recommendations, studies indicate significant underutilization of ACEI in clinical practice.
  • Understanding ACEI utilization patterns is crucial for improving HF patient outcomes.

Purpose of the Study:

  • To evaluate the utilization rates of ACEI in hospitalized heart failure patients.
  • To identify the patterns of ACEI prescribing and dosing at discharge.
  • To determine factors associated with the underutilization of ACEI in this population.

Main Methods:

  • Retrospective observational study design.
  • Analysis of data from 321 hospitalized heart failure patients at University Malaya Medical Centre (UMMC).
  • Assessment of ACEI prescription, dosage, and associated clinical factors.

Main Results:

  • Only 57% of hospitalized HF patients received ACEI.
  • Over half (51.2%) of patients on ACEI were discharged on low doses (≤25% of target dose).
  • Significant factors associated with underutilization included serum potassium/creatinine levels, chronic renal failure, and concurrent medications (e.g., frusemide, ARBs).

Conclusions:

  • ACEI utilization in heart failure management at UMMC is considerably low.
  • Suboptimal dosing of ACEI is prevalent among treated patients.
  • Addressing factors like renal function and drug interactions is essential to improve ACEI therapy in HF.

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