Evaluation of the use of evidence-based angiotensin-converting enzyme inhibitor criteria for the treatment of congestive heart failure: opportunities for pharmacists to improve patient outcomes.

摘要

BACKGROUND: The under-utilization and under-dosing of angiotensin-converting enzyme inhibitors (ACEIs) in patients with congestive heart failure (CHF) continues to be a problem observed in clinical practice. OBJECTIVE: To develop and implement drug use evaluation (DUE) criteria for the use of ACEIs in patients with CHF which could be used by pharmacists to ensure that all eligible patients receive an ACEI at an appropriate dose. METHODS: A retrospective chart review of all patients discharged from the study institution with a diagnosis of CHF during the period of March 1 to July 31, 1998 was conducted using the DUE criteria developed. RESULTS: Of the 138 patients evaluated, only 68.6% were discharged on ACEI therapy. Additionally, only 40% of those discharged on an ACEI achieved target dose. Multiple regression analysis revealed that males were 2.43 times more likely to be discharged on an ACEI than females, while those on concomitant diuretics or digoxin were less likely to be discharged on an ACEI (25% and 18%, respectively). CONCLUSIONS: The application of these DUE criteria by pharmacists in hospital and community practice has the potential to improve utilization and dosing of this important class of medications for the management of the symptoms and progression of CHF.