A survey of the dose of ACE inhibitors prescribed by general physicians for patients with heart failure

Aim-To describe the pattern of angiotensin converting enzyme (ACE) inhibito r doses prescribed by general physicians for patients with chronic heart fa ilure and to review the current evidence favouring the use of higher doses. Design-A retrospective survey of the medications of 125 patients with chron ic heart failure (in both inpatient and outpatient settings) was carried ou t between December 1999 and February 2000. Results-Altogether 18.4% of patients surveyed were receiving no ACE inhibit or, the majority of these (65%) having a contraindication to such an agent. Of those patients who were prescribed an ACE inhibitor, 65% were receiving a high dose. The majority of patients who were prescribed a low dose of AC E inhibitor had no identifiable contraindication to receiving a higher dose . Of all patients with chronic heart failure studied, 25% were receiving ei ther no ACE inhibitor or only a low dose in the absence of contraindication . Conclusion-Since no objectively measurable variable has been shown to share a clear relationship with the outcome benefits of ACE inhibitors, no conve nient and reliable assessment exists for determining when an adequate dose has been reached for each patient. There is an abundance of evidence favour ing high dose ACE inhibitors in heart failure; evidence for the role of low doses is much less clear. The fact that only half of the patients with chr onic heart failure were found to be receiving a high dose of ACE inhibitor is probably testimony to inaccurate perceptions and unreliable assumptions among physicians. It is likely that a change in current prescribing pattern s would benefit patients with chronic heart failure.