Long-term trends of angiotensin-converting enzyme inhibitor and angiotensin-receptor blocker use after heart failure hospitalization in community-dwelling seniors

Abstract 

Background

Despite multiple trials demonstrating the benefit of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) for heart failure (HF) patients with systolic dysfunction, studies have reported underuse of these drugs. Little is known about recent trends in the use of ACEI/ARB in community-dwelling seniors.

Methods

Using administrative data from pharmacy assistance programs and Medicare in two states, we identified all patients hospitalized for HF between 1995 and 2004 who survived ≥90 days after discharge. The study outcomes were filled prescriptions for an ACEI or ARB within 90 days after discharge. We assessed age, gender, race, and comorbidities. Multivariate modified Poisson regression was used to analyze temporal trends.

Results

Of 54,453 patients identified, 26,166 (48%) filled prescriptions for ACEIs/ARBs within 90 days after discharge from HF, but utilization of these drugs did not increase during the decade studied. Among those who were on ACEI/ARB before the index hospitalization, 74% filled at least one ACEI/ARB prescription within 90 days after the hospitalization. These results were similar among the subgroup of HF patients with prior MI.

Conclusions

Use of ACEI/ARB after discharge from HF hospitalization in seniors did not increase over the decade of observation and may still be inadequate.

Keywords: Angiotensin-converting enzyme inhibitor, Angiotensin-receptor blockers, Heart failure, Utilization, Trend, Elderly