Improving practice patterns in heart failure through a national cardiological network: the case of ACE-inhibitors.
BACKGROUND
Despite the well-established benefits of ACE-inhibitors in chronic heart failure (CHF), current treatment rates and prescribed doses are lower than those proven to improve survival. We evaluated whether participation in a specialist network and the use of a common database would impact on the compliance with CHF guidelines.


METHODS
We analyzed the rate and determinants of ACE-inhibitor use and prescribed doses among 8102 patients with CHF enrolled at 133 cardiology centers participating in a national network.


RESULTS
6625 patients (82%) took ACE-inhibitors, most commonly enalapril (41%, mean dose 16 +/- 9 mg), captopril (25%, mean dose 74 +/- 44 mg) and lisinopril (14%, mean dose 13 +/- 8 mg). The predictors of the non-prescription of ACE-inhibitors were: female gender (odds ratio--OR 1.46, 95% confidence interval-CI 1.28-1.67), older age (OR 1.01, 95% CI 1.01-1.02), valvular etiology (OR 1.87, 95% CI 1.60-2.20), NYHA class III-IV (OR 1.25, 95% CI 1.09-1.42) and creatinine levels > 2.5 mg/dl (OR 5.19, 95% CI 3.36-8.02). Conversely a left ventricular ejection fraction < 30% (OR 0.78, 95% CI 0.65-0.94) and a hypertensive (OR 0.69, 95% CI 0.55-0.86) or idiopathic (OR 0.67, 95% CI 0.57-0.78) etiology increased the rate of ACE-inhibitor prescription. Low ACE-inhibitor doses were prescribed to 26.4% of cases.


CONCLUSIONS
The IN-CHF database, an educational and organizational effort led by a national cardiology society, demonstrates that high rates of ACE-inhibitor treatment may be achieved in routine clinical practice in a cardiology setting.
Porcu
Maurizio
M
Heart Failure and Cardiac Transplant Unit, G. Brotzu Hospital, Cagliari, Italy. centro_studi@anmco.it
Opasich
Cristina
C
Scherillo
Marino
M
Lucci
Donata
D
De Maria
Renata
R
Di Tano
Giuseppe
G
Maggioni
Aldo P
AP
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D019992:Databases as Topic; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care
D000806:Angiotensin-Converting Enzyme Inhibitors