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Underutilization of Angiotensin Converting Enzyme Inhibitors among Heart Failure Patients

Lean, Q.Y., and Shamsuddin N., and Wan Ahmad W.A., (2008) Underutilization of Angiotensin Converting Enzyme Inhibitors among Heart Failure Patients. Medical Journal of Malaysia, 63 (3). pp. 216-221. ISSN 0300-5283

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University of Malaya. Faculty of Medicine. Dept. of Pharmacy.
University of Malaya. Faculty of Medicine. Dept. of Pharmacy.
University of Malaya. Faculty of Medicine. Dept. of Medicine.


There are well established guidelines regarding the use of Angiotensin converting enzyme inhibitors (ACEI) in the management of heart failure (HF). In spite of that, many studies has documented underutilization of ACEI. Thus, this retrospective observational study aimed to evaluate the utilization of ACEI, to identify the pattern of ACEI use and the factors that might contribute to underutilization of ACEI. The target population was hospitalized HF patients in University Malaya Medical Centre (UMMC). Of 321 hospitalized HF patients, only 57% of them were treated with ACEI. 51.2% of the patients treated with ACEI received low dose (≤ 25% from target dose) at discharge. Factors that have significant association with the underutilization of ACEI included serum potassium with creatinine, chronic renal failure and other concurrent medications used (frusemide, aspirin, potassium chloride, calcium channel blockers and angiotensin receptor blockers). The findings indicated that the utilization of ACEI in the management of HF in UMMC is considerably low.

Item Type:Journal
Additional Information:We would like to thank the staff of Patient Medical Record Centre of UMMC for facilitating us in obtaining the patients’ files.
Keywords:Heart Failure, Angiotensin converting enzyme inhibitors, Underutilization
Subjects:R Medicine, Dentistry, Pharmacy, Nursing
ID Code:4281

1. Davis RC, Hobbs FDR, Lip GYH. ABC of heart failure: history and epidemiology. BMJ 2000; 320: 39-42.

2. Bleumink GS, Knetsch AM, Sturkenboom MCJM et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and pronogsis of heart failure. Eur Heart J 2004; 25: 1614-619.

3. Hunt SA, Baker DW, Chin MH et al. ACC/AHA 2005 guidelines for the diagnosis and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines (writing Committee to Uptake the 2001 Guidelines for Evaluation and Management of Heart Failure) ACC/AHA 2005 guidelines update for the diagnosis and management of chronic heart failure in the adult: summary article’, JACC 2005; 46: 116-43.

4. Swedberg K, Cleland J, Dargie H et al. Task force for diagnosis and treatment of chronic heart failure of European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for diagnosis and treatment of chronic heart failure of European Society of Cardiology. Eur Heart J 2005; 26: 115-40.

5. Garg R, Yusuf S. Overview of randomized trials of angioensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA 1995; 273: 1450-6.

6. Rogers WJ, Johnstone DE, Yusuf S et al. Quality of life among 5025 patients with left ventricular dysfunction randomized between placebo and enalapril: the studies of left ventricular dysfunction. JACC 1994; 23: 393-400.

7. Masoudi FA, Rathore SS, Wang Y et al. National patterns of use and effectiveness of angiotensin converting enzyme inhibitors in older patients with heart failure and left ventricular systolic dysfunction. Circulation 2004; 110: 724-31.

8. Bungard TJ, McAlister FA, Johnson JA, Tsuyuki RT. Underutilization of angiotensin converting enzyme inhibitors in patients with congestive heart failure. Drugs 2001; 61: 2021-33.

9. Lenzen MJ, Boersma E, Scholte op Reimer WJM et al. Underutilization of evidence-based drug treatment in patients with heart failure is only partially explained by dissimilarity to patients enrolled in landmark trials: a report from the Euro Heart Survey on Heart Failure. Eur Heart J 2005; 26: 2706-13.

10. Ministry of Health and Academy of Medicine Malaysia. Clinical Practice Guidelines on Heart Failure 1999. Ministry of Health, Malaysia, 1999.

11. Pharmaceutical Services Division and the Clinical Research Centre. Malaysian Statistics on Medicines 2004. The National Medicines Use Survey. Ministry of Health, Malaysia, 2004.

12. Large State Peer Review Organization Consortium (LSPROC). Heart failure treatment with angiotensin-converting enzyme inhibitors in hospitalized Medicare patients in 10 large states’, Arch Int Med 1997; 57: 1103-8.

13. Komajda M, Follath F, Swedberg K et al. The EuroHeart failure survey programme: a survey on the quality of care among patients with heart failure in Europe: Part 2: Treatment. Eur Heart J 2003; 24: 464-75.

14. Boyles PJ, Peterson GM, Bleasel MD, Vial JH. Undertreatment of congestive heart failure in an Australian setting. J Clin Pharm Ther 2004; 29: 15-22.

15. Packer M, Poole-Wilson PA, Armstrong PW et al. Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. Circulation 1999; 100: 2312-8.

16. Lonn E. Dose response of ACE inhibitors: implications of the SECURE trial. Curr Control Trials Cardiovasc Med 2001; 2: 155-9.

17. Echemann M, Zannad F, Briancon S et al. Determinants of angiotensin converting enzyme inhibitor prescription in severe heart failure with left ventricular systolic dysfunction: The EPICAL study. Am Heart J 2000; 139: 624-31.

18. Lopez-Sendon J, Swedberg K, Mcmurray J et al. Expert consensus document on angiotensin converting enzyme inhibitors in cardiovascular diseases. Eur Heart J 2004; 25: 1454-70.

19. Bart BA, Ertl G, Held P et al. Contemporary management of patients with left ventricular systolic dysfunction. Result from the study of patients intolerant of converting enzyme inhibitors (SPICE) registry. Eur Heart 1999; 20: 1182-190.

20. Philbin EF, Andreaou C, Rocco TA, Lynch LJ, Baker SL. Patterns of angiotensin-converting enzyme inhibitor use in congestive heart failure in two community hospitals. Am J Cardiol 1996; 77: 832-8.

21. Gattis WA, Larsen RL, Hasselblad V, Bart BA, O’Connor CM. Is optimal angiotensin-converting enzyme inhibitor dosing neglected in elderly patients with heart failure? Am Heart J 1998; 136: 43-8.

22. Hood S, Taylor S, Roeves A et al. Are there age and sex differences in the investigation and treatment of heart failure? A population-based study. Br J Gen Pract 2000; 50: 559-63.

23. Dulin BR, Krum H. Drug therapy of chronic heart failure in the elderly: the current state of clinical-trial evidence. Curr Opin Cardiol 2006; 21: 393-99.

24. Ahmed A, Kiefe CI, Allman RM, Sims RV, DeLong JF. Survival benefits of angiotensin-converting enzyme inhibitors in older heart failure patients with perceived contraindications. J Am Geriatr Soc 2002; 50: 1659-666.

25. Ahmed A, Centor RM, Weaver MT, Perry GJ. A propensity score analysis of the impact of angiotensin-converting enzyme inhibitors on long-term survival of older adults with heart failure and perceived contraindications. Am Heart J 2005; 149: 737-43.

26. Bicket DP. Using ACE inhibitors appropriately. Am Fam Physician 2002; 66: 461-68.

27. Frances C, Noguchi H, Massie BM, Browner WS, McClellan M. Are we inhibited? renal insufficiency should not preclude the use of angiotensin converting enzyme inhibitors for patients with myocardial infarction and depressed left ventricular function. Arch Int Med 2000; 160: 2645-50.

28. National Kidney Foundation. (2004). Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines on Hypertension and Antihypertensive agents in chronic kidney failure 2004. Bibliographic formats for citing electronic information, []

29. Maschio G, Alberti D, Janin G et al. Effect of the angiotenin converting enzyme inhibitor benazepil on the progression of chronic renal insufficiency. N Eng J Med 1996; 334: 939-45.

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