Fischer, M. and Baessler, A. and Hengstenberg, C. and Holmer, S. and Mayer, B. and Loewel, H. and Riegger, G. and Klein, G. and Schunkert, Heribert (2001) Inappropriate implementation of guideline-recommended use of ACE inhibitors after acute myocardial infarction in patients with left ventricular dysfunction. ZEITSCHRIFT FUR KARDIOLOGIE, 90 (2). 104-+. ISSN 0300-5860
Full text not available from this repository. (Request a copy)Abstract
Several reports indicate the benefit of ACE inhibitors for patients with left ventricular systolic dysfunction after acute myocardial infarction (MI). We sought to determine the implementation of the treatment guidelines in patient samples from the general population. Furthermore we aimed to identify patient characteristics associated with the use of ACE inhibitors. Screening of two MI-registries allowed the identification of 226 MI patients with left ventricular dysfunction. Patients were considered to be eligible for ACE inhibitor therapy when a EF less than or equal to 40% was documented in the patient records of cardiac rehabilitation clinics (REG-MI, n = 147) or detected by standardised echocardiography (KORA, n = 78). On average 5.5 years following MI, a standardised questionnaire and a detailed medical history was obtained. Specifically, information was collected regarding current medication and potential contraindications for ACE inhibitors. MI patients with LV dysfunction received ACE inhibitors in 62% (REG-MI) and 45% (KORA). The doses prescribed were substantially smaller than target doses used in the large-scale studies (REG-MI: 40 +/- 4%, KORA: 23 +/- 3%, % of target doses). Only 13% (REG-MI) and 3% (KORA) received more than 50% of the target dosage. Additionally, actual doses of the most frequently used ACE inhibitors were significantly different (captopril: 23 +/- 2%, enalapril: 42 +/- 5% of target doses). The likelihood of receiving ACE inhibitors was significantly higher in patients with written recommendation for such medication (odds ratio 6.02, confidence interval 1.93-20.16) and in patients visiting cardiologists (odds ratio 3.69, confidence interval 1.26-11.07) as revealed by multivariate analysis of the REG-MI database. Despite national and international guidance, a large proportion of MI patients with left ventricular dysfunction is not receiving ACE inhibitors, and when used, the doses prescribed are markely smaller than target doses used in clinical trials that established the utility of these drugs. Medical care by cardiologists and written recommendation of ACE inhibition in patient records were independent: predictors of a more appropriate prescription of ACE inhibitors.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | CONVERTING ENZYME-INHIBITORS; HEALTH-CARE PROFESSIONALS; CHRONIC HEART-FAILURE; SECONDARY PREVENTION; ANGIOTENSIN-II; POPULATION; STATEMENT; MORBIDITY; MORTALITY; DISEASE; ACE-inhibitors; drug use; myocardial infarction; secondary prevention |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 15 Feb 2022 13:57 |
| Last Modified: | 15 Feb 2022 13:57 |
| URI: | https://pred.uni-regensburg.de/id/eprint/41802 |
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