HEART-FAILURE BETWEEN 1986 AND 1994 - TEMPORAL TRENDS IN DRUG-PRESCRIBING PRACTICES, HOSPITAL READMISSIONS, AND SURVIVAL AT AN ACADEMIC-MEDICAL-CENTER

Since 1987, publications in widely circulated medical journals have re ported improved survival and lower hospital readmission rates when pat ients with heart failure and systolic dysfunction are treated with ang iotensin-converting enzyme (ACE) inhibitors. We describe changes in AC E inhibitor use among patients hospitalized with heart failure between 1986 and 1993. Simultaneous trends in readmissions and survival rates are reported. Subjects were 612 consecutive patients hospitalized wit h a principal diagnosis of heart failure at an academic medical center during the period of Sept. 1, 1986, to Dec. 31, 1987 (interval I) or during the period Aug. 1, 1992, to Nov. 30, 1993 (interval II). Medica l records were reviewed for 434 patients, consisting of all patients h ospitalized with heart failure during interval II and a randomly selec ted 50% subset of patients hospitalized during interval I. Among 145 p atients with systolic dysfunction whose medical records were reviewed, ACE inhibitor prescriptions significantly increased between interval I and interval II (43% vs 71%, p < 0.01, odds ratio 3.22, 95% confiden ce interval 1.62 to 6.42). Prescriptions of ACE inhibitors combined wi th digoxin and a diuretic also increased (37% vs 56%, p = 0.02, odds r atio 2.22, 95% confidence interval 1.14 to 4.32). Among all 612 patien ts, 6-month heart failure readmission rates increased from 13% to 21% (p = 0.02, odds ratio 1.79, 95% confidence interval 1.10 to 2.82). The re was no significant change in survival rate between interval I and i nterval II, however, survival rate was marginally significantly improv ed among patients with systolic dysfunction. Our results suggest that drug-prescribing practices have significantly changed between 1986 and 1993. The absence of observed improvement in outcomes may result from changes in hospital admission criteria for heart failure.