OBJECTIVES: This study identifies acute precipitants of hospitalization and evaluates utilization of angiotension-converting enzyme inhibitors in patients admitted with congestive heart failure. METHODS: Cross-sectional chart-review study was done of 435 patients admitted nonelectively from February 1993 to February 1994 to an urban university hospital with a complaint of shortness of breath or fatigue and evidence of congestive heart failure. RESULTS: The most common identifiable abnormalities associated with clinical deterioration prior to admission were acute anginal chest pain (33%), respiratory infection (16%), uncontrolled hypertension with initial systolic blood pressure > or = 180 mm Hg (15%), atrial arrhythmia with heart rate > or = 120 (8%), and noncompliance with medications (15%) or diet (6%); in 34% of patients, no clear cause could be identified. After exclusion of those who were already on a different vasodilator or who had relative contraindications, 18 (32%) of the patients with ejection fractions < or = 0.35 measured prior to admission were not taking an angiotensin-converting enzyme inhibitor on presentation to the hospital. CONCLUSIONS: Interventions to improve compliance, the control of hypertension, and the appropriate use of angiotensin-converting enzyme inhibitors may prevent many hospitalizations of heart-failure patients.
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机译：目的：本研究确定了住院的急性沉淀物，并评估了充血性心力衰竭患者使用血管紧张素转换酶抑制剂的情况。方法：对1993年2月至1994年2月间因非自愿入院但因呼吸急促或乏力以及充血性心力衰竭而住院的435例患者进行横断面图审查研究。结果：入院前与临床恶化相关的最常见可辨认异常是急性心绞痛胸痛（33％），呼吸道感染（16％），初始收缩压≥180 mm Hg（15％）的不受控制的高血压，心房心率>或= 120的心律不齐（8％），不遵医嘱（15％）或饮食不规律（6％）;在34％的患者中，无法确定明确的原因。在排除那些已经使用其他血管扩张药或有相对禁忌症的患者后，入院前测得射血分数≤0.35的患者中有18（32％）位在就诊时未服用血管紧张素转换酶抑制剂。结论：为改善依从性，控制高血压以及适当使用血管紧张素转换酶抑制剂的干预措施可能会阻止许多心衰患者住院。
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