Compliance with and dosing of angiotensin-converting-enzyme inhibitors before and after hospitalization

Compliance with and dosing of angiotensin-converting-enzyme (ACE) inhibitors as they occur before and after hospitalization for heart failure were studied, and factors predictive of compliance with and dosing of ACE inhibitors after hospitalization were identified. Two hundred thirty-six patients hospitalized with heart failure between October 1, 1995, and April 30, 1996, were identified. Compliance with and use and dosing of ACE inhibitors were examined over the 180-day period before admission and the 180-day period after discharge using an integrated pharmacy and medical claims database. Use of an ACE inhibitor was defined as at least one claim for an ACE inhibitor over the period examined, and dosing was assessed by calculating the mean percentage of an adequate daily dose dispensed. Before hospitalization 109 patients (46.2%) used ACE inhibitors, and after hospitalization 148 (62.7%) used them--a significant increase. ACE inhibitor use before hospitalization was a predictor of postdischarge use. Younger patients were more likely to take ACE inhibitors after hospitalization than older ones, and men had better compliance after hospitalization than women. Additional analyses revealed that, among hospitalized patients, compliance was lower in individuals who also took an antidepressant. Dosing increased from 72% to 85% of an adequate daily dose after hospitalization among patients who took ACE inhibitors during both prehospitalization and posthospitalization periods. However, almost one third of hospitalized patients stopped taking their ACE inhibitor within six months of hospital discharge. The study found few significant predictors of patient compliance after hospitalization. Dosing of ACE inhibitors before and after hospitalization needs to be improved.