David W. Baker, MD, MPH; Stephen D. Persell, MD, MPH; Karen S. Kmetik, PhD
Potential Financial Conflicts of Interest: None disclosed.
Baker DW, Persell SD, Kmetik KS. Elevated Creatinine Levels and Quality of Care in Heart Failure. Ann Intern Med. 2007;147:672. doi: 10.7326/0003-4819-147-9-200711060-00019
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Published: Ann Intern Med. 2007;147(9):672.
We agree that severe renal insufficiency is not a contraindication to using an ACE inhibitor or ARB for patients with heart failure. However, some of these patients will have a severe decline in renal function after starting ACE inhibitor or ARB therapy, requiring discontinuation of treatment. Note that if a patient with severe renal insufficiency tolerates ACE inhibitor or ARB treatment, the patient is represented in both the numerator and the denominator. A physician can “get credit” for treating such a patient successfully but does not “fail” the measure if a patient does not tolerate the treatment.
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