Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker adherence in patients with primary versus secondary diagnosis of heart failure.

CONTEXT: It is unknown whether hospitalization for a secondary diagnosis of heart failure (HF) impacts adherence to current HF guidelines. National HF databases that benchmark quality of care currently do not report on adherence based on whether HF is the primary or secondary diagnosis.

OBJECTIVE: To describe angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) utilization at time of discharge in hospitalized patients with a primary or secondary diagnosis of systolic HF.

STUDY DESIGN: Six-month observational chart review.

METHODS: Patients were included if they were hospitalized with a primary or secondary diagnosis of HF, had an ejection fraction of < or =40%, and were more than 18 years of age. Guideline adherence was defined as appropriate if an ACEI or ARB was prescribed at discharge or if there was a documented contraindication.

RESULTS: Of 204 patients in the study, 170 and 34 patients had a primary or secondary diagnosis of HF, respectively. Eighty-six percent of patients with a primary diagnosis of HF were discharged with an ACEI or ARB, whereas 71% of patients with a secondary diagnosis of HF were discharged with an ACEI or ARB (P = .029).

CONCLUSION: Patients with a primary diagnosis of HF are more likely to be discharged on an ACEI or ARB (if indicated) than those with a secondary diagnosis. Identifying and evaluating the need for an ACEI or ARB in hospitalized patients with a secondary diagnosis of HF offers practitioners an opportunity for improved patient care through better adherence to national guidelines.