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

Maurizio Porcu, Cristina Opasich, Marino Scherillo, Donata Lucci, Renata De Maria, Giuseppe Di Tano, Aldo P. Maggioni, G. Scaffidi, C. Valtorta, A. Salustri, F. Amaddeo, G. Barbato, N. Aspromonte, M. Renzi, L. Mantini, C. Frattaroli, A. Mariani, G. Di Marco, G. Levantesi, N. ColonnaA. Montano, O. Di Maggio, G. Toscano, V. Capuano, M. Scherillo, P. Sensale, O. Maiolica, N. Maurea, D. Miceli, A. Somelli, F. Napolitano, P. Provvisiero, M. R. Di Muro, P. Bottiglieri, F. Rufolo, N. Ciriello, E. Angelini, C. Andriulo, F. De Santis, F. Cocco, A. Zecca, A. Pennetta, F. Mariello, F. Magliari, A. De Giorgi, V. Santoro, S. Pede, A. Renna, O. De Donno, E. De Lorenzi, G. Polimeni, V. A. Russo, R. Mangia, F. P. Cariello, M. Affinita, F. Perticone, C. Cloro, G. Misuraca, R. Caporale, P. Chiappetta, E. Tripodi, F. Tassone, S. Salituri, C. Errigo, G. Meringolo, L. Donnangelo, G. Canonico, R. Coco, M. Franco, A. Coglitore, A. Donato, G. Di Tano, D. Cento, C. De Gregorio, M. Mongiovì, A. M. Schillaci, U. Mirto, F. Clemenza, F. Ingrillì, B. Aloisi, M. Dadea, L. Pistis, G. Pili, S. Piras, I. Maoddi

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)730-737
Number of pages8
JournalItalian Heart Journal
Volume3
Issue number12
Publication statusPublished - Dec 1 2002

Fingerprint

Angiotensin-Converting Enzyme Inhibitors
Heart Failure
Cardiology
Databases
Lisinopril
Enalapril
Captopril
Stroke Volume
Prescriptions
Creatinine
Odds Ratio
Guidelines
Confidence Intervals
Survival
Therapeutics

Keywords

  • ACE-inhibitors
  • Chronic heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Porcu, M., Opasich, C., Scherillo, M., Lucci, D., De Maria, R., Di Tano, G., ... Maoddi, I. (2002). Improving practice patters in heart failure through a national cardiological network: The case of ACE-inhibitors. Italian Heart Journal, 3(12), 730-737.

Improving practice patters in heart failure through a national cardiological network : The case of ACE-inhibitors. / Porcu, Maurizio; Opasich, Cristina; Scherillo, Marino; Lucci, Donata; De Maria, Renata; Di Tano, Giuseppe; Maggioni, Aldo P.; Scaffidi, G.; Valtorta, C.; Salustri, A.; Amaddeo, F.; Barbato, G.; Aspromonte, N.; Renzi, M.; Mantini, L.; Frattaroli, C.; Mariani, A.; Di Marco, G.; Levantesi, G.; Colonna, N.; Montano, A.; Di Maggio, O.; Toscano, G.; Capuano, V.; Scherillo, M.; Sensale, P.; Maiolica, O.; Maurea, N.; Miceli, D.; Somelli, A.; Napolitano, F.; Provvisiero, P.; Di Muro, M. R.; Bottiglieri, P.; Rufolo, F.; Ciriello, N.; Angelini, E.; Andriulo, C.; De Santis, F.; Cocco, F.; Zecca, A.; Pennetta, A.; Mariello, F.; Magliari, F.; De Giorgi, A.; Santoro, V.; Pede, S.; Renna, A.; De Donno, O.; De Lorenzi, E.; Polimeni, G.; Russo, V. A.; Mangia, R.; Cariello, F. P.; Affinita, M.; Perticone, F.; Cloro, C.; Misuraca, G.; Caporale, R.; Chiappetta, P.; Tripodi, E.; Tassone, F.; Salituri, S.; Errigo, C.; Meringolo, G.; Donnangelo, L.; Canonico, G.; Coco, R.; Franco, M.; Coglitore, A.; Donato, A.; Di Tano, G.; Cento, D.; De Gregorio, C.; Mongiovì, M.; Schillaci, A. M.; Mirto, U.; Clemenza, F.; Ingrillì, F.; Aloisi, B.; Dadea, M.; Pistis, L.; Pili, G.; Piras, S.; Maoddi, I.

In: Italian Heart Journal, Vol. 3, No. 12, 01.12.2002, p. 730-737.

Research output: Contribution to journalArticle

Porcu, M, Opasich, C, Scherillo, M, Lucci, D, De Maria, R, Di Tano, G, Maggioni, AP, Scaffidi, G, Valtorta, C, Salustri, A, Amaddeo, F, Barbato, G, Aspromonte, N, Renzi, M, Mantini, L, Frattaroli, C, Mariani, A, Di Marco, G, Levantesi, G, Colonna, N, Montano, A, Di Maggio, O, Toscano, G, Capuano, V, Scherillo, M, Sensale, P, Maiolica, O, Maurea, N, Miceli, D, Somelli, A, Napolitano, F, Provvisiero, P, Di Muro, MR, Bottiglieri, P, Rufolo, F, Ciriello, N, Angelini, E, Andriulo, C, De Santis, F, Cocco, F, Zecca, A, Pennetta, A, Mariello, F, Magliari, F, De Giorgi, A, Santoro, V, Pede, S, Renna, A, De Donno, O, De Lorenzi, E, Polimeni, G, Russo, VA, Mangia, R, Cariello, FP, Affinita, M, Perticone, F, Cloro, C, Misuraca, G, Caporale, R, Chiappetta, P, Tripodi, E, Tassone, F, Salituri, S, Errigo, C, Meringolo, G, Donnangelo, L, Canonico, G, Coco, R, Franco, M, Coglitore, A, Donato, A, Di Tano, G, Cento, D, De Gregorio, C, Mongiovì, M, Schillaci, AM, Mirto, U, Clemenza, F, Ingrillì, F, Aloisi, B, Dadea, M, Pistis, L, Pili, G, Piras, S & Maoddi, I 2002, 'Improving practice patters in heart failure through a national cardiological network: The case of ACE-inhibitors', Italian Heart Journal, vol. 3, no. 12, pp. 730-737.
Porcu M, Opasich C, Scherillo M, Lucci D, De Maria R, Di Tano G et al. Improving practice patters in heart failure through a national cardiological network: The case of ACE-inhibitors. Italian Heart Journal. 2002 Dec 1;3(12):730-737.
Porcu, Maurizio ; Opasich, Cristina ; Scherillo, Marino ; Lucci, Donata ; De Maria, Renata ; Di Tano, Giuseppe ; Maggioni, Aldo P. ; Scaffidi, G. ; Valtorta, C. ; Salustri, A. ; Amaddeo, F. ; Barbato, G. ; Aspromonte, N. ; Renzi, M. ; Mantini, L. ; Frattaroli, C. ; Mariani, A. ; Di Marco, G. ; Levantesi, G. ; Colonna, N. ; Montano, A. ; Di Maggio, O. ; Toscano, G. ; Capuano, V. ; Scherillo, M. ; Sensale, P. ; Maiolica, O. ; Maurea, N. ; Miceli, D. ; Somelli, A. ; Napolitano, F. ; Provvisiero, P. ; Di Muro, M. R. ; Bottiglieri, P. ; Rufolo, F. ; Ciriello, N. ; Angelini, E. ; Andriulo, C. ; De Santis, F. ; Cocco, F. ; Zecca, A. ; Pennetta, A. ; Mariello, F. ; Magliari, F. ; De Giorgi, A. ; Santoro, V. ; Pede, S. ; Renna, A. ; De Donno, O. ; De Lorenzi, E. ; Polimeni, G. ; Russo, V. A. ; Mangia, R. ; Cariello, F. P. ; Affinita, M. ; Perticone, F. ; Cloro, C. ; Misuraca, G. ; Caporale, R. ; Chiappetta, P. ; Tripodi, E. ; Tassone, F. ; Salituri, S. ; Errigo, C. ; Meringolo, G. ; Donnangelo, L. ; Canonico, G. ; Coco, R. ; Franco, M. ; Coglitore, A. ; Donato, A. ; Di Tano, G. ; Cento, D. ; De Gregorio, C. ; Mongiovì, M. ; Schillaci, A. M. ; Mirto, U. ; Clemenza, F. ; Ingrillì, F. ; Aloisi, B. ; Dadea, M. ; Pistis, L. ; Pili, G. ; Piras, S. ; Maoddi, I. / Improving practice patters in heart failure through a national cardiological network : The case of ACE-inhibitors. In: Italian Heart Journal. 2002 ; Vol. 3, No. 12. pp. 730-737.
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abstract = "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.",
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author = "Maurizio Porcu and Cristina Opasich and Marino Scherillo and Donata Lucci and {De Maria}, Renata and {Di Tano}, Giuseppe and Maggioni, {Aldo P.} and G. Scaffidi and C. Valtorta and A. Salustri and F. Amaddeo and G. Barbato and N. Aspromonte and M. Renzi and L. Mantini and C. Frattaroli and A. Mariani and {Di Marco}, G. and G. Levantesi and N. Colonna and A. Montano and {Di Maggio}, O. and G. Toscano and V. Capuano and M. Scherillo and P. Sensale and O. Maiolica and N. Maurea and D. Miceli and A. Somelli and F. Napolitano and P. Provvisiero and {Di Muro}, {M. R.} and P. Bottiglieri and F. Rufolo and N. Ciriello and E. Angelini and C. Andriulo and {De Santis}, F. and F. Cocco and A. Zecca and A. Pennetta and F. Mariello and F. Magliari and {De Giorgi}, A. and V. Santoro and S. Pede and A. Renna and {De Donno}, O. and {De Lorenzi}, E. and G. Polimeni and Russo, {V. A.} and R. Mangia and Cariello, {F. P.} and M. Affinita and F. Perticone and C. Cloro and G. Misuraca and R. Caporale and P. Chiappetta and E. Tripodi and F. Tassone and S. Salituri and C. Errigo and G. Meringolo and L. Donnangelo and G. Canonico and R. Coco and M. Franco and A. Coglitore and A. Donato and {Di Tano}, G. and D. Cento and {De Gregorio}, C. and M. Mongiov{\`i} and Schillaci, {A. M.} and U. Mirto and F. Clemenza and F. Ingrill{\`i} and B. Aloisi and M. Dadea and L. Pistis and G. Pili and S. Piras and I. Maoddi",
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month = "12",
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TY - JOUR

T1 - Improving practice patters in heart failure through a national cardiological network

T2 - The case of ACE-inhibitors

AU - Porcu, Maurizio

AU - Opasich, Cristina

AU - Scherillo, Marino

AU - Lucci, Donata

AU - De Maria, Renata

AU - Di Tano, Giuseppe

AU - Maggioni, Aldo P.

AU - Scaffidi, G.

AU - Valtorta, C.

AU - Salustri, A.

AU - Amaddeo, F.

AU - Barbato, G.

AU - Aspromonte, N.

AU - Renzi, M.

AU - Mantini, L.

AU - Frattaroli, C.

AU - Mariani, A.

AU - Di Marco, G.

AU - Levantesi, G.

AU - Colonna, N.

AU - Montano, A.

AU - Di Maggio, O.

AU - Toscano, G.

AU - Capuano, V.

AU - Scherillo, M.

AU - Sensale, P.

AU - Maiolica, O.

AU - Maurea, N.

AU - Miceli, D.

AU - Somelli, A.

AU - Napolitano, F.

AU - Provvisiero, P.

AU - Di Muro, M. R.

AU - Bottiglieri, P.

AU - Rufolo, F.

AU - Ciriello, N.

AU - Angelini, E.

AU - Andriulo, C.

AU - De Santis, F.

AU - Cocco, F.

AU - Zecca, A.

AU - Pennetta, A.

AU - Mariello, F.

AU - Magliari, F.

AU - De Giorgi, A.

AU - Santoro, V.

AU - Pede, S.

AU - Renna, A.

AU - De Donno, O.

AU - De Lorenzi, E.

AU - Polimeni, G.

AU - Russo, V. A.

AU - Mangia, R.

AU - Cariello, F. P.

AU - Affinita, M.

AU - Perticone, F.

AU - Cloro, C.

AU - Misuraca, G.

AU - Caporale, R.

AU - Chiappetta, P.

AU - Tripodi, E.

AU - Tassone, F.

AU - Salituri, S.

AU - Errigo, C.

AU - Meringolo, G.

AU - Donnangelo, L.

AU - Canonico, G.

AU - Coco, R.

AU - Franco, M.

AU - Coglitore, A.

AU - Donato, A.

AU - Di Tano, G.

AU - Cento, D.

AU - De Gregorio, C.

AU - Mongiovì, M.

AU - Schillaci, A. M.

AU - Mirto, U.

AU - Clemenza, F.

AU - Ingrillì, F.

AU - Aloisi, B.

AU - Dadea, M.

AU - Pistis, L.

AU - Pili, G.

AU - Piras, S.

AU - Maoddi, I.

PY - 2002/12/1

Y1 - 2002/12/1

N2 - 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.

AB - 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.

KW - ACE-inhibitors

KW - Chronic heart failure

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