Heart failure treatment: the state of Austrian clinical practice--the Cor survey. Cor Survey Study Group

The aim of this observational study was to evaluate how patients with heart failure (HF) are treated in Austria and which variables may influence usage and dosage of angiotensin-converting enzyme (ACE) inhibitors. One hundred fifty-five hospital departments throughout Austria took part by responding to questionnaires on 4331 patients with a primary or secondary diagnosis of HF who were discharged during November 1996. A total of 1896 patients (44%) were taking an ACE inhibitor at admission, 868 (20%) patients were started on ACE inhibitor therapy in the hospital, and 64% were discharged while taking an ACE inhibitor. Triple therapy (ACE inhibitor, glycoside, and diuretic) was used in 34% of the patients. Conditions favoring ACE inhibitor therapy were hypertension (77%), diabetes (75% insulin-dependent, 70% non-insulin dependent), and age below 75 years (71%). Functional stage, gender, presence of chronic obstructive pulmonary disease or atrial fibrillation, and a history of stroke had little influence on the prescription of ACE inhibitors. They were used infrequently and, if so, in low doses in patients with a serum creatinine levels above 2.0 mg/dL, the aged, or those with dementia. Geographic location also affected medication use. More educational efforts and more scientific evidence on the issue of adequacy of different doses will be needed in order to take full advantage of the beneficial potential of ACE inhibitors in the therapy of patients with HF in the future.