Improving practice patters in heart failure through a national cardiological network: The case of ACE-inhibitors

Background. Despite the well-established benefits of ACE-inhibitors in chronic heart failure (CHF), current treatment rates and prescribed doses are lower than those proven to improve survival. We evaluated whether participation in a specialist network and the use of a common database would impact on the compliance with CHF guidelines. Methods. We analyzed the rate and determinants of ACE-inhibitor use and prescribed doses among 8102 patients with CHF enrolled at 133 cardiology centers participating in a national network. Results. 6625 patients (82%) took ACE-inhibitors, most commonly enalapril (41%, mean dose 16 ± 9 mg), captopril (25%, mean dose 74 ± 44 mg) and lisinopril (14%, mean dose 13 ± 8 mg). The predictors of the non-prescription of ACE-inhibitors were: female gender (odds ratio-OR 1.46, 95% confidence interval-CI 1.28-1.67), older age (OR 1.01, 95% CI 1.01-1.02), valvular etiology (OR 1.87, 95% CI 1.60-2.20), NYHA class III-IV (OR 1.25, 95% CI 1.09-1.42) and creatinine levels > 2.5 mg/dl (OR 5.19, 95% CI 3.36-8.02). Conversely a left ventricular ejection fraction < 30% (OR 0.78, 95% CI 0.65-0.94) and a hypertensive (OR 0.69, 95% CI 0.55-0.86) or idiopathic (OR 0.67, 95% CI 0.57-0.78) etiology increased the rate of ACE-inhibitor prescription. Low ACE-inhibitor doses were prescribed to 26.4% of cases. Conclusions. The IN-CHF database, an educational and organizational effort led by a national cardiology society, demonstrates that high rates of ACE-inhibitor treatment may be achieved in routine clinical practice in a cardiology setting.