Author + information
- Received November 24, 2003
- Revision received January 5, 2004
- Accepted January 13, 2004
- Published online June 2, 2004.
- Javed Butler, MD, MPH, FACC*,‡,§∥,* (, )
- Patrick G. Arbogast, PhD†,
- James Daugherty, MS†,
- Manoj K. Jain, MD, MPH∥,
- Wayne A. Ray, PhD†,‡ and
- Marie R. Griffin, MD, MPH†,‡,§
- ↵*Reprint requests and correspondence:
Dr. Javed Butler, Cardiology Division, 383-PRB, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Objectives This study was designed to assess outpatient angiotensin-converting enzyme inhibitor (ACEI) use after heart failure (HF) hospitalization.
Background Assuring therapy with ACEIs at discharge after HF hospitalization is a key Medicare quality measure. The benefits of such quality improvement attempts will be limited if therapy is not continued long-term.
Methods To assess the factors associated with filling an ACEI prescription in the 30 days postdischarge and the proportion of patients who filled such prescriptions subsequently up to 365 days postdischarge, we studied 219 patients with depressed ejection fraction (EF) specifically and 960 HF patients in general.
Results Sixty-seven percent of patients with depressed EF and 55% of the total cohort were discharged with ACEIs. Overall 81.2%/77.1% (depressed EF/total cohort) of survivors discharged with ACEIs had filled a prescription by 30 days postdischarge; only 66.3%/63.3% were current users at 365 days. In contrast, for patients with no discharge order for ACEIs, only 12.7%/12.0% (depressed EF/total cohort) had filled such a prescription by 30 days and 12.5%/18.8% were current users at 365 days postdischarge. Patients with a discharge order for ACEIs were more likely to fill a prescription within 30 days postdischarge (hazard ratio 10.93, 95% confidence interval 5.28, 22.61, for patients with depressed EF).
Conclusions For patients with HF who are discharged while taking ACEIs, there is a significant decline in use after discharge. Patients not discharged with ACEIs are unlikely to be started as outpatients. Quality improvement efforts therefore need to be focused on both discharge planning and outpatient care.
☆ Supported in part by the Agency for Healthcare Research and Quality, Centers for Education and Research in Therapeutics cooperative agreement (grant #HS 1-0384) and a cooperative agreement with the Food and Drug Administration (FD-U-001641).
The analyses upon which this publication is based were performed under contract number 500-99-TN01, titled “Quality Improvement Organization for the State of Tennessee,” sponsored by the Centers for Medicare and Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care. Ideas and contributions to the authors concerning experience in engaging with issues presented are welcomed.
- Received November 24, 2003.
- Revision received January 5, 2004.
- Accepted January 13, 2004.
- American College of Cardiology Foundation