Related Experiment Video
Updated: Jan 11, 2026
A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs
Published on: February 18, 2022
Utilization and Dose Optimization of Angiotensin-Converting Enzyme Inhibitors in Heart Failure Patients With Reduced
Martin Kampamba1, Ruth Mbanvu1, Jimmy Hangoma2
1Department of Pharmacy, School of Health Sciences University of Zambia Lusaka Zambia.
Insights
Most heart failure patients use Angiotensin-converting enzyme inhibitors (ACEIs), but few receive optimal doses. Improving ACEI therapy requires a multidisciplinary approach to enhance patient outcomes and reduce hospitalizations.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Angiotensin-converting enzyme inhibitors (ACEIs) are crucial for managing chronic heart failure (CHF), reducing morbidity and mortality.
- Optimal high-dose ACEI therapy improves clinical outcomes and quality of life in CHF patients.
- Suboptimal ACEI use is linked to increased hospitalizations, worsening heart failure symptoms, and poorer prognoses.
Purpose of the Study:
- To assess the utilization and dose optimization of ACEIs in heart failure patients at the Adult University Teaching Hospital (AUTH).
Main Methods:
- A cross-sectional study involving adult CHF patients with ejection fraction < 40%.
- Data collected via checklist and analyzed using STATA 15.1.
- Multivariable logistic regression identified factors associated with ACEI utilization and dose optimization.
Main Results:
- Of 292 participants, 71.6% received ACEIs (Enalapril only); only 14.6% were on optimal doses.
- NYHA class II/III and use of ≥5 medications were associated with higher ACEI utilization.
- Diabetes and hypertension were significantly associated with higher likelihood of optimal ACEI dose.
Conclusions:
- While most CHF patients receive ACEIs, optimal dosing remains low.
- A multidisciplinary team approach, including clinical pharmacists, is essential for optimizing ACEI therapy and improving patient outcomes in heart failure.
Background And Aims:
Angiotensin-converting enzyme inhibitors (ACEIs) are well established in reducing morbidity and mortality among patients with chronic heart failure (CHF). Evidence has consistently supported the use of high-dose ACEI therapy, which is recommended to optimize clinical outcomes and enhance patients' quality of life. Suboptimal utilization and under-dosing of these agents are associated with increased rates of hospitalization, worsening symptoms of heart failure, and overall, poor prognoses. We assessed the utilization and dose optimization of ACEIs in heart failure patients at the Adult University Teaching Hospital (AUTH).
Methods:
This was a cross-sectional study conducted among adult patients with with a confirmed diagnosis of CHF and an ejection fraction of < 40%. A checklist was used to collect data, which was subsequently analysed using STATA version 15.1. Multivariable logistic regression was used to determine associated factors.
Results:
Of the 292 study participants, 209 (71.6%) were on ACEIs, with Enalapril being the only drug in use. The study found that only 42 (14.6%) of the patients were taking the optimum doses. The adjusted logistic regression model revealed that New York Heart Association (NYHA) class II (AOR: 3.1, CI: 1.20-8.01, p = 0.018), NYHA class III (AOR: 1.6, CI: 0.72-13.7, p = 0.004), and those taking at least 5 medications (AOR: 1.9, CI: 1.17-3.04, p = 0.010) were more likely to utilize ACEIs. Diabetes mellitus (COR: 4.3, CI: 1.38-13.3, p = 0.012) and having hypertension (COR: 6.2, CI: 2.15-17.9 p = 0.001) were significantly associated with higher likelihood of dose optimization of ACEIs. Hypertension was the most common comorbidity, affecting 183 (62.5%) participants while the majority, 176 (60.4%) of the individuals had less than two comorbidities.
Conclusion:
Although the majority of patients were receiving ACEIs, only a small proportion of these were using optimal dosages. Therefore, a multidisciplinary team approach that includes clinical pharmacists in the medication review and patient monitoring processes would achieve definite outcomes in patients with HF.
Related Concept Videos
01:30Heart Failure V: Medical Management
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:22Heart Failure VI: Adjunct Therapies
01:22Heart Failure Drugs: Diuretics
01:22Heart Failure Drugs: β-Blockers
01:30Heart Failure IV: Classification and Diagnostic Evaluation