Angiotensin converting enzyme inhibition and hospitalisation rates for heart failure in the Netherlands, 1980 to 1999: the end of an epidemic?

Age adjusted hospitalisation rates for heart failure have increased considerably throughout the western world in the 1980s and early 1990s, as documented by reports from New Zealand, the USA, Sweden, Spain, Scotland, and the Netherlands.1,2 Hospitalisations account for as much as 70% of the health care budget spent on heart failure.1 Angiotensin converting enzyme (ACE) inhibition became the cornerstone of heart failure treatment in the 1990s, following demonstration of reduction in mortality and readmissions in patients with heart failure or left ventricular dysfunction enrolled in clinical trials.3 We examined trends in hospitalisations for heart failure and ACE inhibitor prescription rates in the Netherlands from 1980 to 1999. All hospital admissions, including in-hospital deaths, with a first listed discharge diagnosis of heart failure were studied, using the methods described in detail previously.2 Briefly, International classification of diseases , ninth revision (ICD-9) codes 428.x (heart failure), 402.x (hypertensive heart disease), and 429.1 (myocardial degeneration) were used to identify discharges for heart failure. Complete national data on discharges were obtained from Prismant and on Dutch population figures from Statistics Netherlands. From 1980 to 1999 the mean age of patients admitted for heart failure increased from 71.2 to 72.9 years in men and from 75.0 to 77.7 years in women. Age adjusted discharge rates were calculated by direct standardisation to the European standard population. Trends over time in discharge rates were analysed separately for men and women using Poisson regression. The model included calendar year, …