Many Heart Patients Fail to Get Needed Drugs

One-third of those with heart failure aren't prescribed ACE inhibitors

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HealthDay Reporter

MONDAY, Aug. 2, 2004 (HealthDayNews) -- Potentially lifesaving drugs to treat heart failure aren't being prescribed often enough, a new study contends.

Almost one-third of heart-failure patients aren't getting angiotensin-converting enzyme (ACE) inhibitors and therefore face a higher risk of dying, according to the study in the Aug. 3 issue of Circulation.

"The underuse of ACE inhibitors is certainly discouraging and is concordant with pieces of data that indicate quality of medical care needs to be improved," said study author Dr. Frederick A. Masoudi, an assistant professor of medicine at the Denver Health Medical Center.

Many clinical trials have demonstrated the benefits of ACE inhibitors, which work by blocking the effects of angiotensin, an enzyme that causes blood vessels to tighten. ACE inhibitors relax blood vessels, lowering blood pressure and increasing the supply of blood and oxygen to the heart.

"They have proven benefit in congestive heart failure," said Dr. Dan Fisher, a clinical assistant professor of medicine at New York University School of Medicine. ACE inhibitors are specifically prescribed for systolic heart failure, which represents about two-thirds of all cases.

To gauge how well clinical trial results were being translated into practice, the study authors looked at records on 17,456 Medicare patients who had heart failure and left ventricular systolic dysfunction. The people were treated either during the period April 1998 to March 1999 or July 2000 to June 2001.

Sixty-eight percent of the patients were discharged from a hospital with a prescription for an ACE inhibitor, meaning 32 percent were sent home without a prescription.

During the following year, the patients without a prescription had a 14 percent higher risk of dying than the patients who were treated with ACE inhibitors.

The patients for whom doctors seemed least likely to prescribe ACE inhibitors were those with kidney dysfunction, Masoudi said. But overall, the underuse seemed to affect all racial and ethic groups and both genders.

The authors weren't able to determine if patients with prescriptions for ACE inhibitors actually took the drugs. Nor were they able to determine if those without prescriptions later got one at an outpatient facility.

The breakdown could occur anywhere "between information showing a clear benefit and patients actually taking the medication," Fisher said. "No one answer is going to explain everything."

The nation's health-care system is probably the best place to start when thinking about rectifying the discrepancy, Masoudi said.

"We need to work on engineering the system so that it again optimizes the likelihood that a patient who required a certain medicine is going to get it in the right circumstance," he said. Such system changes might include computerized reminders and integrated electronic medical records that offer doctors a more comprehensive view of a patient.

"We need to focus on having a system that facilitates the best evidence-based care," Masoudi said.

More information

The American Heart Association has more on congestive heart failure and ACE inhibitors.

SOURCES: Frederick A. Masoudi, M.D., assistant professor, medicine, Denver Health Medical Center, and the University of Colorado Health Sciences Center, both in Denver; Dan Fisher, M.D., clinical assistant professor, medicine, New York University School of Medicine, New York City; Aug. 3, 2004, Circulation

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