Philbin E F, Andreaou C, Rocco T A, Lynch L J, Baker S L
Department of Medicine and Research Institute, Bassett Healthcare, Copperstown, NY 13326, USA.
Am J Cardiol. 1996 Apr 15;77(10):832-8. doi: 10.1016/s0002-9149(97)89177-1.
Because they provide relief of symptoms and reduce mortality, angiotensin-converting enzyme (ACE) inhibitors have become a highly recommended part of the pharmacologic treatment of patients with congestive heart failure (CHF). Although clinical trials suggest that 80% to 90% of patients with CHF tolerate ACE inhibitors, recent surveys reveal that for fewer than this number of patients are actually receiving these drugs. The reasons for this discrepancy are not known. To better understand physician-prescribing behavior, the current study examined the demographic, clinical, laboratory, and medical care characteristics of patients treated and not treated with ACE inhibitors during hospitalization for decompensated CHF. The charts of a consecutive series of patients admitted to 2 acute care hospitals during 1992 (n = 424) were reviewed and comparisons made between those receiving and not receiving ACE inhibitors at the time of hospital admission and hospital discharge. In addition, measures of in-hospital and postdischarge outcome were compared between the groups. The results revealed significant differences in certain demographic variables (e.g., patient age), clinical measures (e.g., left ventricular ejection fraction and serum creatinine), management issues (e.g., documentation of left ventricular function and documentation of etiology of CHF), and treatment strategies (e.g., ancillary drug use). Few differences were noted in measures of severity of CHF (e.g., New York Heart Association functional class and serum sodium level). Death rates were significantly higher for those not receiving ACE inhibitors. Patterns that emerged that could explain under-prescription ACE inhibitors included older age, worse renal function, left ventricular diastolic dysfunction, use of alternate vasodilators, and overall less intense medical management. Programs to educate care providers regarding the proper use of ACE inhibitors in CHF are recommended.
由于血管紧张素转换酶（ACE）抑制剂能够缓解症状并降低死亡率，已成为充血性心力衰竭（CHF）患者药物治疗中备受推荐的一部分。尽管临床试验表明80%至90%的CHF患者耐受ACE抑制剂，但最近的调查显示，实际接受这些药物治疗的患者数量少于这一比例。这种差异的原因尚不清楚。为了更好地理解医生的处方行为，本研究调查了因失代偿性CHF住院期间接受和未接受ACE抑制剂治疗的患者的人口统计学、临床、实验室及医疗护理特征。回顾了1992年期间连续入住两家急症医院的一系列患者（n = 424）的病历，并对入院时和出院时接受和未接受ACE抑制剂的患者进行了比较。此外，还比较了两组患者的住院期间及出院后的预后指标。结果显示，在某些人口统计学变量（如患者年龄）、临床指标（如左心室射血分数和血清肌酐）、管理问题（如左心室功能记录和CHF病因记录）以及治疗策略（如辅助药物使用）方面存在显著差异。在CHF严重程度指标（如纽约心脏协会功能分级和血清钠水平）方面差异不大。未接受ACE抑制剂治疗的患者死亡率显著更高。出现的能够解释ACE抑制剂处方不足的模式包括年龄较大、肾功能较差、左心室舒张功能障碍、使用其他血管扩张剂以及总体医疗管理力度较小。建议开展相关项目，对医疗服务提供者进行关于在CHF中正确使用ACE抑制剂的教育。
