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Are Patients Aware of Angiotensin-Converting Enzyme Inhibitor–Associated Adverse Effects?

Khoubaeva, Anastasia MD1,2,3; Murray, Kate MSc1,2; Mitchell, Patricia M. RN1,2,*; Zaniboni, Hillary A. BS1,2; Feldman, James A. MD, MPH1,2; Mycyk, Mark B. MD1,2,4

American Journal of Therapeutics: May 2012 - Volume 19 - Issue 3 - p 180–184
doi: 10.1097/MJT.0b013e3181f9c2a0
Original Article

It is important for patients to understand the potential adverse effects (AEs) of their daily medications. Because associated adverse effects (ACEIs) may result in life-threatening angioedema, we sought to assess patients' level of awareness of ACEI AEs, determine if patients have an appropriate action plan in the event of an ACEI AE, determine if a brief educational intervention in the emergency department (ED) could improve knowledge about ACEI AEs. This was a prospective in-person survey conducted between August and December 2008 in a large urban academic ED. The survey instrument was used to collect data on demographics, recognition of ACEI AEs, and action plans. A follow-up survey to assess recall of AEs was done 7 days after ED discharge. Of 208 eligible patients, 113 enrolled: sixty-five (58%) were females, median age was 55 years [interquartile range (IQR) 47–64]. The majority of participants (69%) had a high-school diploma or less. On a 5-point Likert scale (5 = “very important”), the median reported level of overall concern for ACEI AEs was 5 (IQR 4–5). Twenty-seven (25%) of the participants reported being told that ACEIs have potential AEs at the time of the initial prescription. Correct identification of potential ACEI-associated AEs in the ED was variable with a median of 8 of 16 correctly answered questions (IQR 6–10). At follow-up, the median score was 9 (IQR 6–10). There was no association between educational level and number of correct AE responses (P = 0.10). Despite a high level of expressed concern regarding ACEI AEs, patients' knowledge of AEs was poor, and recall was minimally improved at follow-up. Most patients have a plan in the event of an AE.

1Boston University School of Medicine, Boston, MA

2Boston Medical Center, Boston, MA

3University of Chicago Medical Center, Chicago, IL

4Cook County Hospital, Chicago, IL.

The authors have no conflicts of interest to declare.

Address for correspondence: Department of Emergency Medicine, Dowling 1-South, 1 BMC Place, Boston, MA 02118. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.