Angiotensin-converting enzyme inhibitors in heart failure: Physicians' prescribing behavior

Ferreira, Ana Reis; Bettencourt, Paulo; Cortez, Margarida; Araújo, José Paulo; Cerqueira-Gomes, M

doi:10.1016/s1071-9164(97)90029-4

Cited by 14 publications

(8 citation statements)

References 32 publications

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“…Reasons for this may include failure of the cardiovascular community to effectively spread the message of efficacy of this therapy and a lack of willingness by community practitioners to accept that the results of large multicentre studies apply to the routine patient seen in the community. Recent studies, however, would suggest that there is growing use of ACE inhibitors supported by the data from this patient cohort . More extensive application in the cardiology‐treated patients in this group is in keeping with other observations regarding the relative use of ACE inhibitors among cardiologists, internists and family practitioners .…”

Section: Discussionsupporting

confidence: 82%

The basics of heart failure management: are they being ignored?

Horan

Barrett

Mulqueen

et al. 2000

European J of Heart Fail

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Background: Advances have been made in the medical management of congestive heart failure. However, there is concern that these changes may not be transmitted to the heart failure population in the community. Other impediments to improved prognosis, such as failure to apply non-pharmacological strategies and poor patient comprehension may also be prevalent in the community. Aims: The purpose of this study was to assess physician practice and patient knowledge in a heart failure population admitted to a University Hospital in Ireland. Methods: Patients admitted with a primary diagnosis of heart failure were studied. Estimation of ejection fraction was used to subdivide the population into heart failure with impaired and normal systolic function. Patients' course in hospital was noted with reference to management by cardiology or internal medicine, use of angiotensin-converting enzyme inhibition therapy and digoxin and application of dietary and rehabilitative services. Patient knowledge was assessed by questionnaire. Results: Eighty patients were included in this study. Two-thirds of the population had impaired systolic function. The majority of patients were managed by internal medicine physicians, and this population was older and more likely to have normal systolic function. Prescription of converting enzyme inhibitor therapy was more Ž . frequently used in cardiology-managed patients 96 vs. 70%, P -0.05 . Neither group applied dietary or rehabilitative advice to a significant level. Patient comprehension was poor, especially with regard to understanding of medicine and the value of weight measurement. Conclusion: The above data demonstrate a lack of use of rehabilitative and dietary services and poor patient knowledge. These deficiencies may play a role in determining outlook and may impede the expected improvement in prognosis that has been witnessed in large randomised studies. ᮊ

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Section: Discussionsupporting

confidence: 82%

The basics of heart failure management: are they being ignored?

Horan

Barrett

Mulqueen

et al. 2000

European J of Heart Fail

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“…The present study demonstrates that ARB substitution does not completely explain the treatment gap. Clinicians may be reluctant to use ACE inhibitors because of concerns of increased risks of adverse events in some patients (eg, in patients with renal dysfunction) 19,20 or because of the lack of data from clinical trials in other groups. In some cases, systems may not be structured to ensure that patients are receiving optimal care.…”

Section: Masoudi Et Al Use and Effectiveness Of Ace Inhibitors In Hf 729mentioning

confidence: 99%

National Patterns of Use and Effectiveness of Angiotensin-Converting Enzyme Inhibitors in Older Patients With Heart Failure and Left Ventricular Systolic Dysfunction

et al. 2004

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Background-Although ACE inhibitors are underprescribed for heart failure, factors associated with their use are not well described. Furthermore, the effectiveness of ACE inhibitors has been questioned in some populations, potentially contributing to underuse. Our objectives were to assess the correlates of ACE inhibitor use and the relationship between ACE inhibitor prescription and mortality in older patients with heart failure. Methods and Results-We studied a national sample aged Ն65 years who had survived hospitalization for heart failure between April 1998 and March 1999 or July 2000 and June 2001, restricting the analysis to patients with left ventricular systolic dysfunction and without a documented contraindication to use of ACE inhibitors (nϭ17 456). Factors associated with ACE inhibitor prescription at discharge and the relationship between ACE inhibitor prescription and death within 1 year were assessed with hierarchical logistic models. Secondary analyses assessed therapeutic substitution with angiotensin receptor blockers (ARBs). ACE inhibitors were prescribed to only 68% of this ideal cohort, and 76% received either an ACE inhibitor or an ARB. Patient, physician, and hospital factors were weak predictors of prescription, except for serum creatinine (RR for 133 to 221 mol/Lϭ0.87, 95% CI 0.85 to 0.89; RR for Ն222 mol/Lϭ0.53, 95% CI 0.49 to 0.57 compared with Յ132 mol/L). ACE inhibitor prescription was associated with lower crude 1-year mortality (33.0% versus 42.1%, PϽ0.001), lower risk of death after adjustment (RR 0.86, 95% CI 0.82 to 0.90), and lower mortality regardless of patient gender, age, race, or serum creatinine level. Conclusions-ACE inhibitors were widely underprescribed despite evidence of a favorable impact on survival in a broad range of patients with heart failure. These results emphasize the importance of ongoing efforts to translate clinical trial results into practice.

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“…4 Despite these recommendations and clinical data supporting the benefits of ACEIs, patients are often not treated with adequate doses or they are simply not prescribed at all. 5 Given the benefits of ACEI therapy in the aforementioned populations, the lack of ACEI administration is surprising. The reticence of physicians to prescribe ACEIs may in part be related to safety concerns regarding renal failure.…”

Section: Introductionmentioning

confidence: 99%