Is optimal angiotensin-converting enzyme inhibitor dosing neglected in elderly patients with heart failure?
BACKGROUND
The benefit of angiotensin-converting enzyme (ACE) inhibitors on mortality in heart failure has been proved in randomized controlled trials.


METHODS
We prospectively evaluated the prescribing of ACE inhibitors and the prescribing of target ACE inhibitor doses in 43 ambulatory patients with heart failure to identify differences in ACE inhibitor utilization among elderly and nonelderly patients. The prescribed ACE inhibitor dose and other variables were assessed by direct patient interview and information contained in the medical record. Telephone calls were conducted at 3 months to identify the occurrence of clinical events.


RESULTS
Fewer elderly patients were prescribed target ACE inhibitor doses compared with nonelderly patients (21.4% vs 68.8%; p = 0.0136). Elderly patients were more likely to experience an event than nonelderly patients (11 vs 4; p = 0.0074). Elderly patients not receiving target ACE inhibitor doses demonstrated a trend toward more events than elderly patients who were at target doses.


CONCLUSIONS
The data suggest that this group of elderly patients with heart failure who received lower ACE inhibitor doses appeared to be at higher risk for clinical events.
Duke University Medical Center, Department of Medicine, and the Duke Clinical Research Institute, Durham, NC 27710, USA.
W A
WA
Gattis
R L
RL
Larsen
V
V
Hasselblad
B A
BA
Bart
C M
CM
O'Connor
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D019370:Observation; D010865:Pilot Projects; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors