The use of angiotensin-converting enzyme inhibitors in patients with acute myocardial infarction in community hospitals. Michigan State University Inter-Institutional Collaborative Heart (MICH) Study Group.
BACKGROUND
Previous studies documenting underutilization of angiotensin-converting enzyme inhibitors (ACEIs) in acute myocardial infarction (AMI) have been limited to Medicare populations.


OBJECTIVE
This study examines ACEI prescription rates and predictors in a community sample of hospitalized patients with AMI.


METHODS
The charts of 1163 community patients with AMI, prospectively identified at admission between January 1, 1994, and April 30, 1995, were reviewed.


RESULTS
Only 64 of 158 (40%) patients considered ideal candidates for ACEI prescription were discharged with a prescription for an ACEI. In a multivariate logistic regression model, prior ACEI utilization [adjusted odds ration (OR) = 3.26; 95% confidence interval (CI) = 2.05-5.20], presence of congestive heart failure (OR = 2.33; CI = 1.50-3.61) and black race (OR = 2.20; CI = 1.34-3.64) were identified as positive predictors of ACEI prescription. Conversely, lack of left ventricular ejection fraction (LVEF) measurement (OR = 0.46; CI = 0.28-0.75), LVEF > 40 ( OR = 0.27; CI = 0.18-0.40), and acute renal failure (OR = 0.08; CI = 0.01-0.44) were negative predictors. Women were also less likely to be discharged with an ACEI prescription (OR = 0.71; CI = 0.48-1.05). Furthermore, women were significantly less likely to have LVEF measured prior to discharge than were males (77 vs. 85%, p = 0.001).


CONCLUSIONS
This study underscores the need for improvement in the utilization of ACEI in eligible patients with AMI. It also identifies opportunities for improvement in prescription rates, especially in women.
Dwamena
F C
FC
Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, USA.
El-Tamimi
H
H
Watson
R E
RE
Kroll
J
J
Stein
A D
AD
McLane
A
A
Holmes-Rovner
M
M
McIntosh
B
B
Kupersmith
J
J
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D004363:Drug Utilization / Q000592:standards* / Q000639:trends; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012494:Sampling Studies; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors