title: Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge.
abstract: OBJECTIVE
  This study was designed to assess outpatient angiotensin-converting enzyme inhibitor (ACEI) use after heart failure (HF) hospitalization.
  
  
  BACKGROUND
  Assuring therapy with ACEIs at discharge after HF hospitalization is a key Medicare quality measure. The benefits of such quality improvement attempts will be limited if therapy is not continued long-term.
  
  
  METHODS
  To assess the factors associated with filling an ACEI prescription in the 30 days postdischarge and the proportion of patients who filled such prescriptions subsequently up to 365 days postdischarge, we studied 219 patients with depressed ejection fraction (EF) specifically and 960 HF patients in general.
  
  
  RESULTS
  Sixty-seven percent of patients with depressed EF and 55% of the total cohort were discharged with ACEIs. Overall 81.2%/77.1% (depressed EF/total cohort) of survivors discharged with ACEIs had filled a prescription by 30 days postdischarge; only 66.3%/63.3% were current users at 365 days. In contrast, for patients with no discharge order for ACEIs, only 12.7%/12.0% (depressed EF/total cohort) had filled such a prescription by 30 days and 12.5%/18.8% were current users at 365 days postdischarge. Patients with a discharge order for ACEIs were more likely to fill a prescription within 30 days postdischarge (hazard ratio 10.93, 95% confidence interval 5.28, 22.61, for patients with depressed EF).
  
  
  CONCLUSIONS
  For patients with HF who are discharged while taking ACEIs, there is a significant decline in use after discharge. Patients not discharged with ACEIs are unlikely to be started as outpatients. Quality improvement efforts therefore need to be focused on both discharge planning and outpatient care.
authors.affiliation: Department of Preventive Medicine, Vanderbilt University, Nashville, Tennessee 37232, USA. javed.butler@vanderbilt.edu
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: James
authors.initials: J
authors.lastname: Daugherty
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Jain
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Ray
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
mesh_terms: D000359:Aftercare; D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D019985:Benchmarking; D015331:Cohort Studies; D017723:Drug Utilization Review; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013714:Tennessee
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors