Congestive Heart FailureImpact of angiotensin-converting enzyme inhibitor underdosing on rehospitalization rates in congestive heart failure☆
Section snippets
Study design
A retrospective cohort design was used to assess all patients who received diagnostic- related group (DRG) code 127 (CHF) and were admitted at least twice during the 36-month period from January 1, 1993, to December 31, 1995. Principal end points for analysis included time to readmission, defined as the interval in days between the first hospital discharge and the following readmission, and the 90-day readmission rate as used in previous studies.2, 11
Patient selection and data sources
DRG coding was performed by certified
Results
During the 36-month observation period, 314 patients experienced ≥2 admissions for CHF (DRG 127). The demographics of this group are described in Table I. Most of the patients received combination therapy, with nearly half the patients on the full regimen of diuretic, digoxin, and ACE inhibitor. Only 45 of 209 patients (22%) receiving an ACE inhibitor or 45 of 314 (14%) overall received doses consistent with AHCPR recommendations (enalapril ≥20 mg/day).
Kaplan-Meier plots illustrating
Discussion
Present data are consistent with observations in controlled clinical trials in which clear efficacy of ACE inhibitors (in doses of approximately 20 mg of enalapril daily) have been demonstrated to reduce symptoms and hospitalization rates in patients with CHF.5, 7 The Cooperative North Scandanavian Enalapril Survival Study observed a 28% reduction in hospitalizations with the addition of enalapril 20 mg/day to CHF patients already receiving conventional treatment for CHF.6 In the Studies of
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This work was supported in part by a pilot Clinical Pharmacology Training Program Grant FD-T-000889, Buffalo, New York.