Patterns of angiotensin-converting enzyme inhibitor prescriptions, educational interventions, and outcomes among hospitalized XXXX with @entity712 .

@entity1 @entity4688 @entity712 @entity1289 @entity3371 @entity1372
BACKGROUND: Among hospitalized @entity1 with @entity712 , we describe characteristics associated with prescription of angiotensin-converting enzyme ( @entity1289 ) inhibitors in the doses recommended by clinical practice guidelines. We also describe the impact of @entity1289 inhibitor prescriptions, increases in @entity1289 inhibitor dose, and nonpharmacologic educational interventions on readmission-free survival rates. HYPOTHESIS: We hypothesize that care by a cardiologist physician and higher mean arterial blood pressure on admission are associated with receipt of optimal @entity1289 inhibitor doses. We hypothesize that receipt of an @entity1289 inhibitor at discharge and an increase in @entity1289 inhibitor dose during hospitalization are associated with superior readmission-free survival. METHODS: Between January 1, 1992, and December 31, 1993, medical records were reviewed for consecutively hospitalized @entity1 with a principal diagnosis of @entity712 at an academic medical center. Documented instructions and medications prescribed at discharge were abstracted. Deaths and readmissions through December 31, 1994, were identified with the National Death Index and the study institution's administrative data base, respectively. RESULTS: During 1992 and 1993, 387 @entity1 were discharged alive from hospitalization for @entity712 . Among @entity1 discharged on @entity4688 or @entity3371 , 18% received doses recommended by @entity712 clinical practice guidelines. @entity1 discharged on a recommended @entity1289 inhibitor dose were more likely to be African-American and had lower @entity1372 levels and higher mean arterial pressures than @entity1 discharged on lower @entity1289 inhibitor doses. In survival analyses, an increase in @entity1289 inhibitor dose was associated with improved readmission-free survival, independent of left ventricular systolic function type. Receipt of an @entity1289 inhibitor at discharge was also associated with superior readmission-free survival, while nonpharmacologic educational instructions were not associated with improved outcomes. CONCLUSION: Interventions are needed to improve the frequency with which @entity1289 inhibitors are prescribed at recommended doses to hospitalized @entity1 with @entity712 . We conclude that among these @entity1 , receipt of an @entity1289 inhibitor at discharge and an increase in @entity1289 inhibitor dose during hospitalization are each associated with measurable effects on readmission-free survival, while provision of educational instructions as currently practiced is not associated with better outcomes.
