Underutilization and clinical benefits of angiotensin-converting enzyme inhibitors in patients with asymptomatic left ventricular dysfunction

Despite evidence of therapeutic benefit of angiotensin-converting enzyme (A CE) inhibitors for congestive heart failure and asymptomatic left ventricul ar (LV) dysfunction, recent studies suggest that in heart failure patients, rates of ACE inhibitor usage in clinical practice remain low. In this stud y, the medical records of 107 patients with documented LV dysfunction were investigated for patterns of ACE inhibitor usage; 6-month and 1-year outcom es and event rates were evaluated. At index admission, 48% patients did not receive ACE inhibitor treatment, 32% were initiated on treatment, 19% cont inued on a prior regimen, and 1% were discontinued, Patients seen by a card iologist were more likely to receive ACE inhibitor treatment (53% vs 35%, p = 0.172), as were patients with histories of hypertension (60% vs 40%, p = 0.044) or myocardial infarction (56% vs 44%, p = 0.221). Significantly sho rter hospitalizations (5.9 vs 9.5 days, p = 0.001) were noted for patients with on-going ACE inhibitor treatment compared with those receiving newly i nitiated treatment or no treatment. At time of hospital discharge, 102 pati ents were alive. Of 54 patients who received ACE inhibitors, 67% received a n insufficient dose. At a 6-month follow-up, of 51 patients on ACE inhibito rs, 23% died or were readmitted to hospital compared with 55% of nonusers ( p = 0.001). At 1 year, this event rate was 31% amang ACE inhibitor users ve rsus 71% among nonusers (p <0.0001). Bivariate and multivariate analysis re vealed absence of ACE inhibitor use as the only significant variable associ ated with the event rate (p <0.0011). Thus, about half of patients with asy mptomatic LV dysfunction received ACE inhibitors; 2/3 of these did not rece ive a sufficient dose. ACE inhibitor usage increased with involvement of a cardiologist, presence of coexistent hypertension, or prior myocardial infa rction. Ongoing ACE inhibitor therapy was associated with shorter hospitali zations and fewer hospital readmissions or deaths. (C) 2000 by Excerpta Med ico, Inc.