Not prescribing an ACEI at discharge compared to a recommended dose in patients with LVSD was associated with an increased rate of readmission (RR 1.74; 95% CI 1.22-2.48; P=0.005 for trend).
Cohort (n=611)
Yes
Does ACEI use at recommended doses at discharge reduce readmissions in patients hospitalized with heart failure due to LVSD?
Prescription of ACE inhibitors at guideline-recommended doses upon discharge in patients with heart failure and LVSD significantly reduces the rate of readmissions over 21 months.
Effect estimate: RR 1.74 (95% CI 1.22-2.48)
p-value: p=0.005 for the trend
OBJECTIVES: Clinical practice guidelines based on the results of randomized clinical trials recommend that patients with heart failure due to left ventricular systolic dysfunction (LVSD) be treated with angiotensin-converting enzyme inhibitors (ACEI) at doses shown to reduce mortality and readmission. This study examined the relationship between ACEI use at discharge and readmission among patients with heart failure due to LVSD. METHODS AND RESULTS: Data were abstracted from the medical records of 2943 randomly selected patients hospitalized for heart failure in 50 hospitals. The outcome of interest was the number of readmissions occurring up to 21 months after discharge. Six-hundred and eleven patients were eligible for analysis. Compared with patients discharged at a recommended ACEI dose, patients not prescribed an ACEI at discharge had an adjusted rate ratio of readmission (RR) of 1.74 95% confidence interval (CI) 1.22-2.48, while patients prescribed an ACEI at less than a recommended dose had an RR of 1.24 (95% CI 0.91-1.69) (P = 0.005 for the trend). CONCLUSION: Our results show that ACEI use at discharge in patients with LVSD is associated with decreased rate of readmission. These findings suggest that compliance with the ACEI prescribing recommendations listed in clinical practice guidelines for patients with heart failure due to LVSD confers benefit.
Jean-Christophe Luthi (2003) conducted a cohort in Heart failure due to left ventricular systolic dysfunction (LVSD) (n=611). Angiotensin-converting enzyme inhibitors (ACEI) vs. No ACEI or less than recommended dose was evaluated on Number of readmissions occurring up to 21 months after discharge (RR 1.74, 95% CI 1.22-2.48, p=0.005 for the trend). Not prescribing an ACEI at discharge compared to a recommended dose in patients with LVSD was associated with an increased rate of readmission (RR 1.74; 95% CI 1.22-2.48; P=0.005 for trend).