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

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 th...

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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
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description 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
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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 &lt;0.05). The readmission rate was not reduced with daily ACE inhibitor doses of ≤5 mg enalapril, whereas daily doses of ≥10 mg enalapril reduced 90-day readmission rates by 28% compared to those receiving diuretic or digoxin therapy (p &lt;0.05). 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Using a dynamic model, the dose required to achieve 90% to 95% of the theoretical maximum ACE inhibitor effect exceeded 100 mg enalapril daily. Thus, CHF readmission rates are lower when daily ACE inhibitor doses exceed 5 mg enalapril or the equivalent daily, but are unaffected by digoxin or diuretic. Modeled maximum ACE inhibitor benefits require doses 8- to 10-fold higher than current usage patterns.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>9723634</pmid><doi>10.1016/S0002-9149(98)00361-0</doi><tpages>5</tpages></addata></record>
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identifier ISSN: 0002-9149
ispartof The American journal of cardiology, 1998-08, Vol.82 (4), p.465-469
issn 0002-9149
1879-1913
language eng
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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
title Impact of angiotensin-converting enzyme inhibitor underdosing on rehospitalization rates in congestive heart failure
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