Effects of Angiotensin‐Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Therapy After Hospital Discharge on Subsequent Rehospitalization for Acute Myocardial Infarction and Heart Failure

Abstract

A n estimated 7.9 million persons in the United States have experienced acute myocardial infarction (MI) and 5.2 million have been diagnosed with heart failure (HF).1 MI and HF result in elevated morbidity and mortality risks and substantial economic burden.1,2 HF accounts for an estimated 1 million hospital stays annually, and $33.2 billion in direct and indirect costs to society annually. Direct and indirect costs to society for coronary heart disease, of which MI is a major contributor, is estimated at $162 billion annually. 1Up to 74% of patients hospitalized for MI will be readmitted for MI again or another cardiovascular diagnosis within 3 years.3 Among patients hospitalized for HF, 30% to 40% will be readmitted within 6 months.4 A large percent of these readmissions may be preventable if established guidelines for care, including use of medications, were followed.American College of Cardiology ⁄ American Heart Association (ACC ⁄ AHA) guidelines emphasize angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy following acute MI or development of HF as the cornerstone of treatment complemented by aldosterone agonists and b-blockers.5 The guidelines are supported by clinical trials demonstrating the efficacy of ACEIs in reducing mortality and morbidity in patients with HF and MI dating back some 20 years [6][7][8][9] ; and clinical trials demonstrating reduced mortality and morbidity rates in cohorts of MI or HF patients treated with ARB therapies. [10][11][12] In addition, studies of patient adherence to evidence-based pharmacotherapies in MI and HF patients have consistently found a strong association between higher rates of adherence and better outcomes. A population-based, longitudinal study of 31,455 elderly MI survivors between 1999 and 2003 in Ontario found that adherence is positively correlated with long-term survival. 13 An analysis of the effect of b-blockers, aspirin, lipid-lowering agents, and ACEI therapy on survival in a large population treated for MI, HF, and other cardiovascular diseases also found that rates of patient adherence to evidencebased pharmacotherapies were strongly associated with rates of survival at 5 years post discharge.14 A large population-based study in Denmark of HF patients prescribed ACEI, ARB, b-blockers or statins post-discharge reported higher mortality among nonpersistent patients. 15Less is known about the effects of ACEI or ARB therapies on the risk of hospitalization for MI and HF patients, a common and costly event for this patient population. The effectiveness of ACEI or ARB therapies in reducing American College of Cardiology ⁄ American Heart Association guidelines recommend angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy following acute myocardial infarction (MI) or development of heart failure (HF). This study estimated the effects of initiating these therapies after hospitalization for MI or HF on subsequent 1-year rehospitalization rates for MI

Red Blood Cell Distribution Width Is a Predictor of Readmission in Cardiac Patients

“…In previous reports age, gender, race, socioeconomic status, type of insurance, disease burden, weight, nutritional and functional status, length of stay, chronic diseases, and medication use and compliance have been identified as contributors to the likelihood of rehospitalization . Some of these factors have been incorporated in various prediction models that have been developed.…”

“…Three‐quarters of rehospitalizations ($44 billion yearly estimated cost) may be avoidable . Age, gender, race, socioeconomic status, type of insurance, disease burden, weight, nutritional and functional status, length of stay, chronic diseases, and medication use and compliance contribute to the potential for readmission . A screening tool for the detection of potential cases would likely make further case management more efficient, motivating efforts to develop reliable prediction models for risk of readmission …”

Digoxin Use and Lower 30-day All-cause Readmission for Medicare Beneficiaries Hospitalized for Heart Failure

“…18 Based on these observations and that most evidence-based heart failure therapies that reduce hospital admission also reduce readmission, 19,20 we hypothesized that discharge prescription of digoxin will be associated with lower 30-day all-cause readmission in older heart failure patients hospitalized for acute decompensation. Therefore, the objective of the current study was to test the hypothesis that digoxin use is associated with lower 30-day all-cause hospital readmission.…”

Heart Failure Rehospitalization of the Medicare FFS Patient

“…For example, Hess, Preblick, Hill, Plauschinat, and Yaskin (2009) found that ACE inhibitor or ARB postdischarge therapy for heart failure or acute myocardial infarction was associated with lowering of the rehospitalization risk for both heart failure and myocardial infarction. For example, Hess, Preblick, Hill, Plauschinat, and Yaskin (2009) found that ACE inhibitor or ARB postdischarge therapy for heart failure or acute myocardial infarction was associated with lowering of the rehospitalization risk for both heart failure and myocardial infarction.…”