title: Trends and outcomes associated with angiotensin-converting enzyme inhibitors.
abstract: BACKGROUND
  Limited recent data are available describing the patterns of use of angiotensin converting enzyme inhibitor (ACEI) therapy in patients with acute myocardial infarction (AMI), particularly from the more generalizable population-based setting. The purpose of this study was to examine trends in the receipt of ACEIs and associated short-term outcomes in patients hospitalized with AMI in a large Northeastern community.
  
  
  METHODS
  We conducted a community-wide study of 7991 patients hospitalized with AMI in all metropolitan Worcester, Massachusetts, medical centers during 8 annual periods between 1990 and 2003.
  
  
  RESULTS
  Among all patients, 44% received ACEI therapy during their acute hospitalization. There was a marked increase in the use of ACEIs between 1990 (23%) and 2003 (68%), particularly among those who were not on ACEIs before hospitalization. Patients who were previously on ACEIs were more likely to receive this therapy during hospitalization for AMI than were patients who were not previously on this therapy. Patients treated with ACEIs were significantly less likely to die (adjusted odds ratio [OR] 0.33; 95% confidence interval [CI] 0.27-0.41) during hospitalization than were patients who did not receive this therapy, with benefits observed across all subgroups examined.
  
  
  CONCLUSIONS
  The results of this observational study demonstrate marked increases in the use of ACEIs in patients with AMI in the community setting and demonstrate the benefits to be gained from use of this therapy. Despite these encouraging trends, there remains room for more optimal use of this therapy.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester 01655, USA.
authors.forename: Chyke
authors.initials: C
authors.lastname: Doubeni
authors.forename: Carol
authors.initials: C
authors.lastname: Bigelow
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Frederick
authors.initials: F
authors.lastname: Spencer
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.forename: Joel
authors.initials: J
authors.lastname: Gore
authors.forename: Jerry
authors.initials: J
authors.lastname: Gurwitz
authors.forename: Robert
authors.initials: R
authors.lastname: Goldberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004358:Drug Therapy / Q000639:trends; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D016017:Odds Ratio; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors