Angiotensin-converting enzyme inhibitors in XXXX : physicians' prescribing behavior.

@entity1 @entity8 @entity712 @entity1482 @entity1002
BACKGROUND: Several studies document an underuse of angiotensin-converting enzyme inhibitors (ACEIs) in @entity712 ( @entity712 ) @entity1 , despite their proven efficacy and good tolerability. Also, there is some evidence that the doses used in clinical practice are far lower than those used in clinical trials. METHODS AND RESULTS: To identify patterns of ACEI use in @entity712 @entity1 this study examined data collected on admission day regarding demographic, clinical, and medical care characteristics of 355 @entity1 hospitalized because of decompensated @entity712 who were treated with and without ACEIs. Additionally, measures of in-hospital outcome were compared among the two groups. Fifty-eight point six percent of @entity1 were receiving ACEIs at admission and 80.6% were treated with ACEIs during hospitalization. The average ACEI does was low. No differences were observed in age and measures of severity of @entity712 between ACEI-prescribed and nonprescribed @entity1 . Patterns that could explain ACEI underuse included female sex, lower systolic blood pressure, worse renal function, @entity1002 , use of alternate drugs (eg, @entity1482 ), and overall less intense medical management. Patterns associated with the use of lower doses of ACEIs included older age, higher New York Heart Association functional class, and lower systolic blood pressure. In-hospital death rates were significantly higher for @entity1 not treated with ACEIs. CONCLUSIONS: This study suggests that many @entity1 eligible for ACEI treatment were deprived of the advantages of these drugs because of erroneous clinical strategies. Nevertheless, the patterns of ACEI use were similar to those reported by other studies. Clinical trials conducted to determine the risk/benefit ratio of ACEI use in @entity1 with @entity8 and the utility of ACEIs in diastolic @entity712 , as well as programs to educate care providers on proper use of ACEIs in @entity712 @entity1 , are strongly recommended.
