Hospital pharmacists can improve ACE inhibitor use in heart failure patients

By Pam Harrison

TORONTO (Reuters Health) – The use of ACE inhibitors in patients admitted to hospitals for congestive heart failure can be significantly enhanced when hospital pharmacists ensure that all such patients receive an ACE inhibitor, at appropriate dosage, unless otherwise contraindicated.

Results from the Review of Education on ACE inhibitors in Congestive Heart Failure Treatment (REACT) study were presented here at the 33rd professional practice conference program of the Canadian Society of Hospital Pharmacists.

Dr. Ross T. Tsuyuki, associate professor of medicine, University of Alberta, Edmonton, and fellow REACT investigators established a standardized protocol during which hospital pharmacists in 10 hospitals across western Canada assessed all patients admitted for heart failure for eligibility for ACE inhibitor therapy. For those already on an ACE inhibitor on admission, pharmacists were charged with assessing the adequacy of the prescribed dose.

A total of 764 patients were enrolled in REACT. The investigators reported that ACE inhibitor use increased significantly among the patient cohort to 83% on discharge from hospital compared with 58% on hospital admission.

In enalapril dose equivalents, the mean daily dose of the ACE inhibitor prescribed also increased significantly to 14.5 mg/day on discharge from 11.3 mg/day on admission.

As a second stage of the study, the REACT investigators also assessed the impact of a patient support program, in which patients were educated about heart failure and its treatment, versus usual care, in which patients were given a pamphlet on heart failure.

Of the 276 patients involved in this component of the study, adherence to ACE inhibitor therapy was not different between the patient support group at 83.5% compared with the usual care group at 86.2%.

"But interestingly, we did find that the group who received the educational intervention had about half the number of emergency room visits for heart failure episodes [over the six month followup] compared with those in the usual care group," Dr. Tsuyuki told Reuters Health in an interview.

Also, "although the number of hospitalizations was similar between the two groups, if they were hospitalized, patients were hospitalized for about half as many days if they had received the educational intervention compared with the usual care group."

The total cost of care for patients who had been involved in the patient support program was also substantially less at $3,526 per patient at the end of six months than for those who received usual care at $6,312 per patient.

"We wanted the intervention to be something anyone could do, and this is the kind of thing hospital pharmacists are doing anyway. We just standardized the protocol and made it so hospital pharmacists had to seek out heart failure patients and make sure they were on an ACE inhibitor when appropriate. Now we need to convince hospital administrators that we can save about $3,000 per patient with heart failure over six months by implementing this protocol," Dr. Tsuyuki said.

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