Evaluation of the use of evidence-based angiotensin-converting enzyme inhibitor criteria for the treatment of congestive heart failure: opportunitiesfor pharmacists to improve patient outcomes

Background: The under-utilization and underdosing of angiotensin-converting enzyme inhibitors (ACEIs) in patients with congestive heart failure (CHF) continues to be a problem observed in clinical practice. Objective: To develop and implement drug use evaluation (DUE) criteria for the use of ACEIs in patients with CHF which could be used by pharmacists to ensure that all eligible patients receive an ACEI at an appropriate dose. Methods: A retrospective chart review of all patients discharged from the s tudy institution with a diagnosis of CHF during the period of March 1 to Ju ly 31, 1998 was conducted using the DUE criteria developed. Results: Of the 138 patients evaluated, only 68.6% were discharged on ACEI therapy. Additionally, only 40% of those discharged on an ACEI achieved tar get dose. Multiple regression analysis revealed that males were 2.43 times more likely to be discharged on an ACEI than females, while those on concom itant diuretics or digoxin were less likely to be discharged on an ACEI (25 % and 18%, respectively). Conclusions: The application of these DUE criteria by pharmacists in hospit al and community practice has the potential to improve utilization and dosi ng of this important class of medications for the management of the symptom s and progression of CHF.