Impact of angiotensin-converting enzyme inhibitor underdosing on rehospitalization rates in congestive heart failure

• Published in: The American journal of cardiology 1998-08, Vol.82 (4), p.465-469
• Main Authors: Luzier, Aileen Bown, Forrest, Alan, Adelman, Martin, Hawari, Feras I, Schentag, Jerome J, Izzo, Joseph L
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Biological and medical sciences; Cardiology; Cardiotonic Agents - therapeutic use; Cardiovascular system; Cohort Studies; Digoxin - therapeutic use; Diuretics - therapeutic use; Dose-Response Relationship, Drug; Drug therapy; Enalapril - administration & dosage; Female; Heart failure; Heart Failure - drug therapy; Hospitalization; Humans; Male; Medical sciences; Middle Aged; Patient Readmission; Pharmacology. Drug treatments; Retrospective Studies; Severity of Illness Index; Time Factors; Vasodilator agents. Cerebral vasodilators
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(98)00361-0

In a retrospective, cohort design, clinical usage of digoxin, diuretic, and angiotensin-converting enzyme (ACE) inhibitor was assessed in all patients readmitted over a 36-month period for congestive heart failure (CHF) diagnostic-related group (DRG) 127. ACE inhibitor dose-response analysis used the discharge dose of ACE inhibitor, converted to enalapril-equivalent doses and adjusted for renal function. Principal end points were time-to-readmission and 90-day readmission rate. Of 314 total patients, digoxin was used in 72%, diuretic in 86%, and 67% received an ACE inhibitor. Only 22% of those on an ACE inhibitor received currently recommended doses of enalapril ≥20 mg/day or equivalent, whereas 41% received enalapril ≤5 mg/day. Time-to-readmission was increased by an ACE inhibitor (p = 0.002) but not digoxin or diuretic. An ACE inhibitor was the principal covariate of 90-day readmission rate (p