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To the Editor: In their study of patterns of drug therapy and underlying mortality risk in patients with heart failure, Dr Lee and colleagues¹ concluded that patients with congestive heart failure who have the highest risk of mortality have the lowest likelihood of receiving effective drugs, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These paradoxical findings may reflect 2 methodological problems in this study.

First, in assessing the prescription rate for a drug on the day of discharge, it is likely that the decision to prescribe a drug was affected by the patient's use of this same drug prior to the index hospitalization. Although patients who were not using these drugs before hospitalization may have them prescribed at discharge, patients using them before admission may not have needed a new prescription from the hospital-based physician. To assess this possible source of bias, the analysis of . . . [Full Text of this Article]

Samy Suissa, PhD
samy.suissa@clinepi.mcgill.ca
Division of Clinical Epidemiology
Royal Victoria Hospital
Montreal, Quebec

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