CLINICAL DETERMINANTS OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS/ANGIOTENSIN RECEPTOR BLOCKERS USE IN AN EARLY PHASE AFTER ACUTE HEART FAILURE HOSPITALIZATION

Abstract

Objective: To investigate which clinical determinants predict the use of angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) in an early phase after acute heart failure (AHF) hospitalization. Design and method: A prospective two-centre observational cohort study enrolled 1433 dyspnoeic patients consecutively admitted to an emergency department. AHF was the cause of acute dyspnoea in 635 patients (44.3%). The mean age was 69.7 ± 12.1; 42% were female. Medication follow up data for 574 and 567 AHF patients were available 1 and 3 months after discharge, respectively. Predictors for ACEi/ARB use were identified by an univariate analysis and multivariate stepwise analysis. Results: The mean systolic blood pressure (SBP) of AHF (n = 635) patients was 139.5 ± 27.8; 59% had a SBP > = 140 mmHg. ACEi/ARB were prescribed in 59.7%, 47.9% and 46.9% of patients at discharge as well as 1 and 3 months after discharge, respectively. SBP of 140 mmHg was identified as a threshold to receive ACEi/ARB at discharge using ROC analysis (area under the curve 0.595). Univariate and independent predictors of ACEi/ARB use are presented in Table 1.Conclusions: Less than half of patients received ACEi/ARB 1 and 3 months after discharge for AHF. SBP, history of hypertension and chronic kidney disease were identified as independent predictors of treatment with ACEi/ARB in an early phase after AHF hospitalization.