Lifesaving Drugs Underused in Heart Failure

Aug. 3, 2004 -- Nearly a third of people with heart failure who could benefit from treatment with ACE inhibitors aren't receiving the potentially lifesaving drugs, a new study shows.

Researchers found 32% of elderly people with heart failure were discharged from the hospital without prescriptions for ACE inhibitors, and those discharged without receiving the drugs had a 14% higher risk of dying within a year.

Angiotensin-converting enzyme (ACE) inhibitors block the harmful effects of angiotensin, a substance that causes blood vessels to narrow. When blood vessels narrow, the heart has to work harder to pump blood throughout the body. Researchers say that 20 years of research on ACE inhibitors has shown that the drugs are safe and can be lifesaving for people with heart failure, but the drugs remain underprescribed by health care professionals.

The underuse of lifesaving medications in patients with heart failure is a pervasive problem throughout the health care community, says researcher Frederick Masoudi, MD, MSPH, assistant professor of medicine at the University of Colorado Health Sciences Center in Denver, in a news release.

Masoudi says their study provides good evidence to validate current recommendations that all patients with heart failure should be getting ACE inhibitors, unless they have a particular reason to not use the drugs. Reasons not to take them include having a previous problem taking ACE inhibitors. These drugs are specifically recommended for people with "systolic" heart failure in which the main pumping chambers of the heart are weak and not able to effectively pump blood throughout the body.

ACE Inhibitors Underutilized

In the study, researchers reviewed the medical records of more than 17,000 patients over age 65 who were hospitalized with heart failure during two different time periods: April 1998 to March 1999 and July 2000 to June 2001. Only patients with no previous problems from ACE inhibitors were included in the study.

The results appear in today's rapid access issue of Circulation: Journal of the American Heart Association.

Overall, 68% of the elderly heart failure patients received a prescription for ACE inhibitors upon hospital discharge. The proportion of heart failure patients treated with ACE inhibitors was 69% between 1998 and 1999 and 67% between 2000 and 2001.

Researchers say use of newer drugs called angiotensin receptor blockers (ARBs), which are often used as an alternative to ACE inhibitors in some people with heart failure, did not explain the low rates of appropriate treatment. ARBs are often recommended when someone develops a long-lasting cough from ACE inhibitors, a relatively common side effect with these drugs. When considered together, 76% of heart failure patients had a prescription for either an ACE inhibitor or an ARB.

The study also showed that patients treated with ACE inhibitors had a lower risk of death in the first year after leaving the hospital. Thirty-three percent of patients who received ACE inhibitors died within one year after hospital discharge compared with 42% of those who didn't take the drugs.

After adjusting for the severity of disease and other factors, researchers found use of ACE inhibitors was associated with a 14% lower risk of death.