# Utilization and Dose Optimization of Angiotensin‐Converting Enzyme Inhibitors in Heart Failure Patients With Reduced Ejection Fraction: A Cross Sectional Study on Implications for Guideline‐Targeted Therapy

## TL;DR

This study examines how often heart failure patients are prescribed optimal doses of ACE inhibitors and finds that most are not receiving recommended amounts, suggesting a need for better medication management.

## Contribution

The study identifies factors associated with suboptimal ACE inhibitor use and dose optimization in heart failure patients.

## Key findings

- Only 14.6% of patients were on optimal ACE inhibitor doses.
- Diabetes and hypertension were linked to better dose optimization.
- Multidisciplinary teams, including clinical pharmacists, could improve outcomes.

## Abstract

Angiotensin‐converting enzyme inhibitors (ACEIs) are well established in reducing morbidity and mortality among patients with chronic heart failure (CHF). Evidence has consistently supported the use of high‐dose ACEI therapy, which is recommended to optimize clinical outcomes and enhance patients' quality of life. Suboptimal utilization and under‐dosing of these agents are associated with increased rates of hospitalization, worsening symptoms of heart failure, and overall, poor prognoses. We assessed the utilization and dose optimization of ACEIs in heart failure patients at the Adult University Teaching Hospital (AUTH).

This was a cross‐sectional study conducted among adult patients with with a confirmed diagnosis of CHF and an ejection fraction of < 40%. A checklist was used to collect data, which was subsequently analysed using STATA version 15.1. Multivariable logistic regression was used to determine associated factors.

Of the 292 study participants, 209 (71.6%) were on ACEIs, with Enalapril being the only drug in use. The study found that only 42 (14.6%) of the patients were taking the optimum doses. The adjusted logistic regression model revealed that New York Heart Association (NYHA) class II (AOR: 3.1, CI: 1.20–8.01, p = 0.018), NYHA class III (AOR: 1.6, CI: 0.72–13.7, p = 0.004), and those taking at least 5 medications (AOR: 1.9, CI: 1.17–3.04, p = 0.010) were more likely to utilize ACEIs. Diabetes mellitus (COR: 4.3, CI: 1.38–13.3, p = 0.012) and having hypertension (COR: 6.2, CI: 2.15–17.9 p = 0.001) were significantly associated with higher likelihood of dose optimization of ACEIs. Hypertension was the most common comorbidity, affecting 183 (62.5%) participants while the majority, 176 (60.4%) of the individuals had less than two comorbidities.

Although the majority of patients were receiving ACEIs, only a small proportion of these were using optimal dosages. Therefore, a multidisciplinary team approach that includes clinical pharmacists in the medication review and patient monitoring processes would achieve definite outcomes in patients with HF.