The use of angiotensin-converting enzyme inhibitors in patients with acutemyocardial infarction in community hospitals

Background: Previous studies documenting underutilization of angiotensin-co nverting enzyme inhibitors (ACEIs) in acute myocardial infarction (AMI) hav e been limited to Medicare populations. Hypothesis: This study examines ACEI prescription rates and predictors in a community sample of hospitalized patients with AMI. Methods;: The charts of 1163 community patients with AMI, prospectively ide ntified at admission between January 1, 1994, and April 30, 1995, were revi ewed. Results: Only 64 of 158 (40%) patients considered ideal candidates for ACEI prescription were discharged with a prescription for an ACEI. In a multiva riate logistic regression model, prior ACEI utilization [adjusted odds rati on (OR) = 3.26; 95% confidence interval (CI)= 2.05-5.20], presence of conge stive heart failure (OR = 2.33; CI = 1.50-3.61) and blackrace (OR = 2.20; C I = 1.34-3.64) were identified as positive predictors of ACEI prescription. Conversely, lack of left ventricular ejection fraction (LVEF) measurement (OR = 0.46; CI = 0.28-0.75), LVEF > 40 ( OR = 0.27; CI = 0.18-0.40), and ac ute renal failure ( OR = 0.08; CI = 0.01-0.44) were negative predictors. Wo men were also less Likely to be discharged with an ACEI prescription (OR = 0.71; CI = 0.48-1.05). Furthermore, women were significantly less likely to have LVEF measured prior to discharge than were males (77 vs. 85%, p = 0.0 01). Conclusion: This study underscores the need for improvement in the utilizat ion of ACEI in eligible patients with AMI. It also identifies opportunities for improvement in prescription rates, especially in women.