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Routine lifelong use of angiotensin converting enzyme (ACE) inhibitors is recommended for heart failure patients with depressed ejection fraction (the heart's left ventricle pumps only 40 percent or less of blood from the ventricle into the aorta; normal ejection fraction is 55-60 percent), unless such use is contraindicated. Yet a new study shows that nearly half of heart failure patients and one-third of those with depressed ejection fraction were not prescribed ACE inhibitors on hospital discharge. Almost one-third of patients who were discharged with ACE inhibitors had stopped taking them within a year. Considering that almost 50 percent of heart failure patients are readmitted to the hospital within 6 months of discharge, underuse of ACE inhibitors is a significant problem.
Discharge planning for these patients should be improved, suggests Wayne Ray, Ph.D., director of the Vanderbilt Center for Education and Research on Therapeutics (CERT). In a study that was funded in part by AHRQ through the CERTs program (HS10384), researchers assessed the factors associated with filling a prescription for an ACE inhibitor in the 30 days following hospital discharge and the proportion of patients filling such prescriptions up to 1 year after discharge. The study involved 960 heart failure patients, including 219 patients with depressed ejection fraction.
Overall, 81 percent of patients with depressed ejection fraction and 77 percent of general heart failure patients discharged with ACE inhibitors had filled a prescription for an ACE inhibitor within 30 days of discharge. However, only about two-thirds of both groups (66 and 63 percent, respectively) were still using ACE inhibitors 1 year after discharge. Patients with a discharge order for ACE inhibitors were nearly 11 times more likely to fill a prescription within 30 days of discharge than those without a discharge order.
See "Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge," by Javed Butler, M.D, M.P.H., F.A.C.C., Patrick G. Arbogast, Ph.D., James Daugherty, M.S., and others, in the June 2, 2004, Journal of the American College of Cardiology 43(11), pp. 2036-2043.
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