Title |
Use of ACE inhibitors in Fontan: Rational or irrational?
|
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Published in |
International Journal of Cardiology, February 2016
|
DOI | 10.1016/j.ijcard.2016.02.089 |
Pubmed ID | |
Authors |
Thomas G. Wilson, Ajay J. Iyengar, David S. Winlaw, Robert G. Weintraub, Gavin R. Wheaton, Thomas L. Gentles, Julian Ayer, Leeanne E. Grigg, Robert N. Justo, Dorothy J. Radford, Andrew Bullock, David S. Celermajer, Kim Dalziel, Chris Schilling, Yves d'Udekem, The Australia and New Zealand Fontan Registry |
Abstract |
Despite a lack of evidence supporting the use of angiotensin-converting enzyme (ACE) inhibitors in patients with a Fontan circulation, their use is frequent. We decided to identify the rationale for ACE inhibitor therapy in patients within the Australia and New Zealand Fontan Registry. All patients in the Registry taking an ACE inhibitor at last follow up were identified, and a review of medical records was undertaken to determine the rationale for treatment initiation and reasons for treatment continuation or dose increase. In 2015, 36% of the surviving patients in the Registry (462/1268) were taking an ACE inhibitor. Indications for initiation of therapy were ventricular systolic or diastolic dysfunction (29%), atrioventricular valve regurgitation (19%), preservation of normal ventricular function (7%), prolonged effusions at Fontan (6%), hypertension (6%), other (6%) and unknown (2%). No indication was stated in the remaining patients (25%). Those with hypoplastic left heart syndrome were more likely to be on an ACE inhibitor than those with an alternative primary morphology (70% vs 32%; p<0.001). Only 36% of the patients treated with an ACE inhibitor at last follow up (166/462) had an indication that would generally justify treatment in a two-ventricle circulation. It is likely that the use of ACE inhibitors in patients with a Fontan circulation is excessive within our region. The coordination of prospective, multicentre studies and initiatives such as the Australia and New Zealand Fontan Registry will facilitate further investigations to guide treatment decisions in the growing Fontan population. |
X Demographics
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Unknown | 1 | 100% |
Demographic breakdown
Type | Count | As % |
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Practitioners (doctors, other healthcare professionals) | 1 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Japan | 1 | 2% |
Mexico | 1 | 2% |
Unknown | 56 | 97% |
Demographic breakdown
Readers by professional status | Count | As % |
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Other | 10 | 17% |
Researcher | 8 | 14% |
Student > Master | 5 | 9% |
Student > Bachelor | 5 | 9% |
Student > Doctoral Student | 3 | 5% |
Other | 13 | 22% |
Unknown | 14 | 24% |
Readers by discipline | Count | As % |
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Medicine and Dentistry | 33 | 57% |
Pharmacology, Toxicology and Pharmaceutical Science | 2 | 3% |
Biochemistry, Genetics and Molecular Biology | 1 | 2% |
Nursing and Health Professions | 1 | 2% |
Sports and Recreations | 1 | 2% |
Other | 3 | 5% |
Unknown | 17 | 29% |