ACE-ing Angioedema: A National Inpatient Sample Cohort Comparing All-cause Angioedema and ACE-I Induced Angioedema

Introduction: Angioedema, particularly when induced by angiotensin-converting enzyme (ACE) inhibitors, represents a significant clinical concern due to its potential severity, including life-threatening airway obstruction. This study aims to compare the clinical characteristics, management strategies, and outcomes of ACE inhibitor-induced angioedema with angioedema of other etiologies in hospitalized patients. Methodology: A retrospective cohort study was conducted using the National Inpatient Sample database, including 19,331 adult records admitted with angioedema from 2018 to 2020. Patients were categorized into two cohorts: those with ACE inhibitor-associated angioedema ( n = 5611) and those with angioedema from other causes ( n = 13720). The outcomes assessed included hospital length of stay, incidence of acute hypoxemic respiratory failure, need for intubation and mechanical ventilation, and in-hospital mortality rates. Results: Patients with ACE inhibitor-associated angioedema exhibited a shorter average hospital stay (4.1 vs. 5.3 days, P < 0.001) despite a higher incidence of acute hypoxemic respiratory failure (25.3% vs. 22.8%, P = 0.001) and a higher rate of intubation (27.5% vs. 21.6%, P < 0.001). Notably, the ACE inhibitor cohort had a lower mortality rate (0.80% vs. 1.99%, P < 0.001). Conclusion: ACE inhibitor-associated angioedema is characterized by severe respiratory complications necessitating proactive management. Despite increased respiratory failure and intubation rates, patients in this cohort demonstrate a reduced hospital stay and lower mortality, potentially indicating a favorable prognosis when managed effectively. The findings underscore the importance of alternative therapies such as angiotensin receptor blockers to mitigate the risk of angioedema.