IS OPTIMAL ANGIOTENSIN-CONVERTING ENZYME-INHIBITOR DOSING NEGLECTED IN ELDERLY PATIENTS WITH HEART-FAILURE

Background The benefit of angiotensin-converting enzyme (ACE) inhibito rs on mortality in heart failure has been proved in randomized control led trials. Methods We prospectively evaluated the prescribing of ACE inhibitors and the prescribing of target ACE inhibitor doses in 43 amb ulatory patients with heart failure to identify differences in ACE inh ibitor utilization among elderly and nonelderly patients. The prescrib ed ACE inhibitor dose and other variables were assessed by direct pati ent interview and information contained in the medical record. Telepho ne calls were conducted at 3 months to identify the occurrence of clin ical events. Results Fewer elderly patients were prescribed target ACE inhibitor doses compared with nonelderly patients (21.4% vs 68.8%; p = 0.0136). Elderly patients were more likely to experience an event th an nonelderly patients (11 vs 4; p = 0.0074). Elderly patients not rec eiving target ACE inhibitor doses demonstrated a trend toward more eve nts than elderly patients who were at target doses. Conclusion The dat a suggest that this group of elderly patients with heart failure who r eceived lower ACE inhibitor doses appeared to be at higher risk for cl inical events.