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Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge.
J Am Coll Cardiol. 2004 Jun 02; 43(11):2036-43.JACC

Abstract

OBJECTIVES

This study was designed to assess outpatient angiotensin-converting enzyme inhibitor (ACEI) use after heart failure (HF) hospitalization.

BACKGROUND

Assuring therapy with ACEIs at discharge after HF hospitalization is a key Medicare quality measure. The benefits of such quality improvement attempts will be limited if therapy is not continued long-term.

METHODS

To assess the factors associated with filling an ACEI prescription in the 30 days postdischarge and the proportion of patients who filled such prescriptions subsequently up to 365 days postdischarge, we studied 219 patients with depressed ejection fraction (EF) specifically and 960 HF patients in general.

RESULTS

Sixty-seven percent of patients with depressed EF and 55% of the total cohort were discharged with ACEIs. Overall 81.2%/77.1% (depressed EF/total cohort) of survivors discharged with ACEIs had filled a prescription by 30 days postdischarge; only 66.3%/63.3% were current users at 365 days. In contrast, for patients with no discharge order for ACEIs, only 12.7%/12.0% (depressed EF/total cohort) had filled such a prescription by 30 days and 12.5%/18.8% were current users at 365 days postdischarge. Patients with a discharge order for ACEIs were more likely to fill a prescription within 30 days postdischarge (hazard ratio 10.93, 95% confidence interval 5.28, 22.61, for patients with depressed EF).

CONCLUSIONS

For patients with HF who are discharged while taking ACEIs, there is a significant decline in use after discharge. Patients not discharged with ACEIs are unlikely to be started as outpatients. Quality improvement efforts therefore need to be focused on both discharge planning and outpatient care.

Authors+Show Affiliations

Department of Preventive Medicine, Vanderbilt University, Nashville, Tennessee 37232, USA. javed.butler@vanderbilt.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15172409

Citation

Butler, Javed, et al. "Outpatient Utilization of Angiotensin-converting Enzyme Inhibitors Among Heart Failure Patients After Hospital Discharge." Journal of the American College of Cardiology, vol. 43, no. 11, 2004, pp. 2036-43.
Butler J, Arbogast PG, Daugherty J, et al. Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge. J Am Coll Cardiol. 2004;43(11):2036-43.
Butler, J., Arbogast, P. G., Daugherty, J., Jain, M. K., Ray, W. A., & Griffin, M. R. (2004). Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge. Journal of the American College of Cardiology, 43(11), 2036-43.
Butler J, et al. Outpatient Utilization of Angiotensin-converting Enzyme Inhibitors Among Heart Failure Patients After Hospital Discharge. J Am Coll Cardiol. 2004 Jun 2;43(11):2036-43. PubMed PMID: 15172409.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge. AU - Butler,Javed, AU - Arbogast,Patrick G, AU - Daugherty,James, AU - Jain,Manoj K, AU - Ray,Wayne A, AU - Griffin,Marie R, PY - 2003/11/24/received PY - 2004/01/05/revised PY - 2004/01/13/accepted PY - 2004/6/3/pubmed PY - 2004/6/18/medline PY - 2004/6/3/entrez SP - 2036 EP - 43 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 43 IS - 11 N2 - OBJECTIVES: This study was designed to assess outpatient angiotensin-converting enzyme inhibitor (ACEI) use after heart failure (HF) hospitalization. BACKGROUND: Assuring therapy with ACEIs at discharge after HF hospitalization is a key Medicare quality measure. The benefits of such quality improvement attempts will be limited if therapy is not continued long-term. METHODS: To assess the factors associated with filling an ACEI prescription in the 30 days postdischarge and the proportion of patients who filled such prescriptions subsequently up to 365 days postdischarge, we studied 219 patients with depressed ejection fraction (EF) specifically and 960 HF patients in general. RESULTS: Sixty-seven percent of patients with depressed EF and 55% of the total cohort were discharged with ACEIs. Overall 81.2%/77.1% (depressed EF/total cohort) of survivors discharged with ACEIs had filled a prescription by 30 days postdischarge; only 66.3%/63.3% were current users at 365 days. In contrast, for patients with no discharge order for ACEIs, only 12.7%/12.0% (depressed EF/total cohort) had filled such a prescription by 30 days and 12.5%/18.8% were current users at 365 days postdischarge. Patients with a discharge order for ACEIs were more likely to fill a prescription within 30 days postdischarge (hazard ratio 10.93, 95% confidence interval 5.28, 22.61, for patients with depressed EF). CONCLUSIONS: For patients with HF who are discharged while taking ACEIs, there is a significant decline in use after discharge. Patients not discharged with ACEIs are unlikely to be started as outpatients. Quality improvement efforts therefore need to be focused on both discharge planning and outpatient care. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/15172409/Outpatient_utilization_of_angiotensin_converting_enzyme_inhibitors_among_heart_failure_patients_after_hospital_discharge_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735109704005753 DB - PRIME DP - Unbound Medicine ER -