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Letters
December 28, 2005

Risk-Treatment Mismatch for Heart Failure—Reply

Author Affiliations
 

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;294(24):3087-3088. doi:10.1001/jama.294.24.3087-b

In Reply: Dr Suissa raises 2 issues about our study of the risk-treatment mismatch in patients with heart failure. Regarding the potential impact of preadmission drug therapy, we performed the suggested stratified analysis and found that the risk-treatment mismatch was present for all strata. Among patients with left ventricular ejection fraction of less than 40% without limiting comorbidities who were taking ACE inhibitors or ARB antagonists before admission, treatment rates at discharge for low-, average-, and high-risk groups were 91%, 87%, and 74%, respectively (P for trend <.001). Among patients not taking ACE inhibitors or ARB antagonists before admission, the rates were 82%, 68%, and 43%, respectively (P for trend <.001). For patients taking β-adrenoreceptor antagonists before admission, treatment rates at discharge for low-, average-, and high-risk groups were 83%, 71%, and 50%, respectively (P for trend <.001) and in those not taking β-adrenoreceptor antagonists before admission, the rates were 26%, 18%, and 11%, respectively (P for trend <.001). The findings were similar when drug use at 90 days was examined.

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