Clinical audit ACE inhibitors and heart failure in hospital: any diVerence between cardiologists and general physicians?

Cardiologists and generalists have been reported to diverge in terms of their self-reported use of angiotensinconverting enzyme (ACE) inhibitors, but information on their actual use of ACE inhibitors has been lacking. In order to assess ACE inhibitor use in patients with heart failure in a teaching hospital and any diVerences between specialties we studied all patients in the Western Infirmary of Glasgow between 1 April and 1 October 1996 with an echocardiogram showing moderate or severe left ventricular systolic dysfunction (n=236). We found that most patients were on an ACE inhibitor (66%), 12% had been tried but found to be intolerant, 10% had not been tried because of a contraindication, but 12% had not been tried despite no contraindication. Of those on treatment, 58% were on a dose used in a major survival study (38% of all patients). Most patients were treated by a cardiologist (64%). Of these, more were on an ACE inhibitor (77% vs 53%, p<0.01), fewer had been tried but found intolerant (11% vs 18%), and fewer had never been tried (11% vs 29%, p<0.01), irrespective of whether they had a contraindication (5% vs 18%, p<0.01) or not (6% vs 12%). More were on a dose used in a major survival study (48% vs 31%, p<0.05). We conclude that, despite improvements over time, ACE inhibitors are still under-used, sometimes without good reason. There are also diVerences in the use of ACE inhibitors between cardiologists and generalists which may aVect outcome, and could aVect resource utilisation.