A survey of the dose of ACE inhibitors prescribed by general physicians for patients with heart failure
R McMullana, B Silkeb
a Department of
Medicine, Belfast City Hospital, Belfast, b Department of Therapeutics and Pharmacology,
Queen's University of Belfast, Belfast
Correspondence to: Dr Ronan McMullan, Kelvin Laboratories, Royal Victoria Hospital, Belfast, UK ronanmcmullan{at}hotmail.com
Submitted 8 November
2000;
Accepted 27 June 2001
AIM
To describe the pattern of
angiotensin converting enzyme (ACE) inhibitor doses prescribed by
general physicians for patients with chronic heart failure and to
review the current evidence favouring the use of higher doses.
DESIGNA retrospective survey of
the medications of 125 patients with chronic heart failure (in both
inpatient and outpatient settings) was carried out between December
1999 and February 2000.
RESULTSAltogether 18.4% of
patients surveyed were receiving no ACE inhibitor, the majority of
these (65%) having a contraindication to such an agent. Of those
patients who were prescribed an ACE inhibitor, 65% were receiving a
high dose. The majority of patients who were prescribed a low dose of
ACE inhibitor had no identifiable contraindication to receiving a
higher dose. Of all patients with chronic heart failure studied, 25%
were receiving either no ACE inhibitor or only a low dose in the
absence of contraindication.
CONCLUSIONSince no objectively
measurable variable has been shown to share a clear relationship with
the outcome benefits of ACE inhibitors, no convenient and reliable
assessment exists for determining when an adequate dose has been
reached for each patient. There is an abundance of evidence favouring
high dose ACE inhibitors in heart failure; evidence for the role of low
doses is much less clear. The fact that only half of the patients with
chronic heart failure were found to be receiving a high dose of ACE
inhibitor is probably testimony to inaccurate perceptions and
unreliable assumptions among physicians. It is likely that a change in
current prescribing patterns would benefit patients with chronic heart failure.
Keywords: ACE inhibitors; dosing regimen; heart failure
© 2001 by The Fellowship of Postgraduate Medicine
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
-
Austin, J., Williams, R., Ross, L., Moseley, L., Hutchison, S.
(2005). Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure. Eur J Heart Fail
7: 411-417
[Abstract] [Full Text] -
Roman-Sanchez, P., Conthe, P., Garcia-Alegria, J., Forteza-Rey, J., Montero, M., Montoto, C., for the Heart Failure Working Group of the Spanish,
(2005). Factors influencing medical treatment of heart failure patients in Spanish internal medicine departments: a national survey. QJM
98: 127-138
[Abstract] [Full Text] -
Shah, S, Davies, M K, Cartwright, D, Nightingale, P
(2004). Management of chronic heart failure in the community: role of a hospital based open access heart failure service. Heart
90: 755-759
[Abstract] [Full Text]
- Full Text
- Full Text (PDF)
- Submit a response
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
- Citation Map
Services
- Email this link to a friend
- Similar articles in this journal
- Similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
