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Clinical Outcomes of Heart Failure Patients with Optimal Dose of Angiotensin – Converting Enzyme (ACE) Inhibitor

Author : Y.B. Utomo, M.S. Rohman, S.Widito, D. Sargowo
Upload Date : 19-04-2018

Background: Optimal dose of Angiotensin Converting Enzyme inhibitors (ACEI) can lower mortality and morbidity of heart failure patients, but in daily practice, achieving optimal doses is often challenging because of side effects or co-morbidity, and also related to patient’s compliance. Only 33% of patients with heart failure receive the target dose, despite good tolerability of that dose in up to 80 % of clinical trials.

Aim: Assess the clinical outcome of optimal doses ACEI in heart failure patients.

Methods: This prospective cohort study included 300 heart failure patients treated in Saiful Anwar Hospital, with inclusion criterias were all heart failure patients aged over 18 years treated by cardiologist and got ACEI therapy. The data was analyzed with significance cut off p ≤ 0.05. Clinical outcomes were inhospital and 30 days post discharge mortality due to cardiovascular causes, also rehospitalization within 30 days after discharge.

Results: From 300 samples, 171 got therapy ACEI and only 29 patients got the optimal dose of ACEI. The patient’s average age was 58 ± 12 years, and 61.4% were male. Inhospital mortality significantly decrease in optimal dose of ACEI group (p = 0.009). 30-days mortality after discharge and rehospitalization also decreased with optimal dose of ACEI therapy, but not statistically significant (p = 0.375 and p = 0.184). Subanalysis showed optimal dose of ramipril was more superior than captopril in decreasing inhospital mortality (p = 0.032).

Conclusion: Heart failure patients with suboptimal doses ACEI seemed to have greater risk of death and heart failure rehospitalization compared with they who got optimal doses.

KEYWORDS : ACEI, Heart Failure, Mortality, Rehospitalization.


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