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Risk-Treatment Mismatch for Heart Failure—Reply
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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  -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 -adrenoreceptor antagonists before admission, . . . [Full Text of this Article]
Douglas S. Lee, MD, PhD;
Jack V. Tu, MD, PhD;
Andreas Laupacis, MD, MSc
alaupacis@ices.on.ca
Institute for Clinical Evaluative Sciences
University of Toronto
Toronto, Ontario
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