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Elevated Creatinine Levels and Quality of Care in Heart Failure
- David W. Baker, MD, MPH;
- Stephen D. Persell, MD, MPH; and
- Karen S. Kmetik, PhD
- From Feinberg School of Medicine, Northwestern University, Chicago, IL 60611.
IN RESPONSE:
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 …
