PATTERNS OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITOR USE IN CONGESTIVE-HEART-FAILURE IN 2 COMMUNITY HOSPITALS

Because they provide relief of symptoms and reduce mortality, angioten sin-converting enzyme (ACE) inhibitors have become a highly recommende d port of the pharmacologic treatment of patients with congestive hear t failure (CHF). Although clinical trials suggest that 80% to 90% of p atients with CHF tolerate ACE inhibitors, recent surveys reveal that f ar fewer than this number of patients are actually receiving these dru gs. The reasons for this discrepancy are not known. To better understa nd physician-prescribing behavior, the current study examined the demo graphic, clinical, laboratory, and medical care characteristics of pat ients treated and not treated with ACE inhibitors during hospitalizati on for decompensated CHF. The charts of a consecutive series of patien ts admitted to 2 acute care hospitals during 1992 (n = 424) were revie wed and comparisons made between those receiving and not receiving ACE inhibitors at the time of hospital admission and hospital discharge. In addition, measures of in-hospital and postdischarge outcome were co mpared between the groups. The results revealed significant difference s in certain demographic variables (e.g., patient age), clinical measu res (e.g., left ventricular ejection fraction and serum creatinine), m anagement issues (e.g., documentation of left ventricular function and documentation of etiology of CHF),and treatment strategies (e.g., anc illary drug use). Few differences were noted in measures of severity o f CHF (e.g., New York Heart Association functional class and serum sod ium level). Death rates were significantly higher for those not receiv ing ACE inhibitors. Patterns that emerged that could explain under-pre scription ACE inhibitors included older age, worse renal function, lef t ventricular diastolic dysfunction, use of alternate vasodilators, an d overall less intense medical management. Programs to educate core pr oviders regarding the proper use of ACE inhibitors in CHF are recommen ded.