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| Predicate | Object |
|---|---|
| rdf:type | |
| lifeskim:mentions | |
| pubmed:issue |
4
|
| pubmed:dateCreated |
1998-9-16
|
| pubmed:abstractText |
In a retrospective, cohort design, clinical usage of digoxin, diuretic, and angiotensin-converting enzyme (ACE) inhibitor was assessed in all patients readmitted over a 36-month period for congestive heart failure (CHF) diagnostic-related group (DRG) 127. ACE inhibitor dose-response analysis used the discharge dose of ACE inhibitor, converted to enalapril-equivalent doses and adjusted for renal function. Principal end points were time-to-readmission and 90-day readmission rate. Of 314 total patients, digoxin was used in 72%, diuretic in 86%, and 67% received an ACE inhibitor. Only 22% of those on an ACE inhibitor received currently recommended doses of enalapril > or = 20 mg/day or equivalent, whereas 41% received enalapril < or = 5 mg/day. Time-to-readmission was increased by an ACE inhibitor (p = 0.002) but not digoxin or diuretic. An ACE inhibitor was the principal covariate of 90-day readmission rate (p <0.05). The readmission rate was not reduced with daily ACE inhibitor doses of < or = 5 mg enalapril, whereas daily doses of > or = 10 mg enalapril reduced 90-day readmission rates by 28% compared to those receiving diuretic or digoxin therapy (p <0.05). Using a dynamic model, the dose required to achieve 90% to 95% of the theoretical maximum ACE inhibitor effect exceeded 100 mg enalapril daily. Thus, CHF readmission rates are lower when daily ACE inhibitor doses exceed 5 mg enalapril or the equivalent daily, but are unaffected by digoxin or diuretic. Modeled maximum ACE inhibitor benefits require doses 8- to 10-fold higher than current usage patterns.
|
| pubmed:language |
eng
|
| pubmed:journal | |
| pubmed:citationSubset |
AIM
|
| pubmed:chemical |
http://linkedlifedata.com/resource/pubmed/chemical/Angiotensin-Converting Enzyme...,
http://linkedlifedata.com/resource/pubmed/chemical/Cardiotonic Agents,
http://linkedlifedata.com/resource/pubmed/chemical/Digoxin,
http://linkedlifedata.com/resource/pubmed/chemical/Diuretics,
http://linkedlifedata.com/resource/pubmed/chemical/Enalapril
|
| pubmed:status |
MEDLINE
|
| pubmed:month |
Aug
|
| pubmed:issn |
0002-9149
|
| pubmed:author | |
| pubmed:issnType |
Print
|
| pubmed:day |
15
|
| pubmed:volume |
82
|
| pubmed:owner |
NLM
|
| pubmed:authorsComplete |
Y
|
| pubmed:pagination |
465-9
|
| pubmed:dateRevised |
2007-11-15
|
| pubmed:meshHeading |
pubmed-meshheading:9723634-Aged,
pubmed-meshheading:9723634-Aged, 80 and over,
pubmed-meshheading:9723634-Angiotensin-Converting Enzyme Inhibitors,
pubmed-meshheading:9723634-Cardiotonic Agents,
pubmed-meshheading:9723634-Cohort Studies,
pubmed-meshheading:9723634-Digoxin,
pubmed-meshheading:9723634-Diuretics,
pubmed-meshheading:9723634-Dose-Response Relationship, Drug,
pubmed-meshheading:9723634-Enalapril,
pubmed-meshheading:9723634-Female,
pubmed-meshheading:9723634-Heart Failure,
pubmed-meshheading:9723634-Humans,
pubmed-meshheading:9723634-Male,
pubmed-meshheading:9723634-Middle Aged,
pubmed-meshheading:9723634-Patient Readmission,
pubmed-meshheading:9723634-Retrospective Studies,
pubmed-meshheading:9723634-Severity of Illness Index,
pubmed-meshheading:9723634-Time Factors
|
| pubmed:year |
1998
|
| pubmed:articleTitle |
Impact of angiotensin-converting enzyme inhibitor underdosing on rehospitalization rates in congestive heart failure.
|
| pubmed:affiliation |
School of Pharmacy, State University of New York at Buffalo, Millard Fillmore Health System, USA.
|
| pubmed:publicationType |
Journal Article,
Research Support, U.S. Gov't, P.H.S.
|