Development and validation of a clinical prediction rule for angiotensin-converting enzyme inhibitor-induced cough. Export

@article{citeulike:563972, abstract = {BACKGROUND: Angiotensin-converting enzyme inhibitors are effective for many cardiovascular diseases and are widely prescribed, but cough sometimes necessitates their withdrawal. OBJECTIVE: To develop and validate a model that predicts, by using information available at first prescription, whether a patient will develop cough within 6 months. DESIGN: Retrospective cohort study with derivation and validation sets. SETTING: Outpatient clinics affiliated with an urban tertiary care hospital. PATIENTS: Clinical data were collected from electronic charts. The derivation set included 1125 patients and the validation set included 567 patients. INTERVENTIONS: None. MEASUREMENTS: Angiotensin-converting enzyme inhibitor-induced cough assessed by predetermined criteria. RESULTS: In the total cohort, 12\% of patients developed angiotensin-converting enzyme inhibitor-induced cough. Independent multivariate predictors of cough were older age, female gender, non-African American (with East Asian having highest risk), no history of previous angiotensin-converting enzyme inhibitor use, and history of cough due to another angiotensin-converting enzyme inhibitor. Patients with a history of angiotensin-converting enzyme inhibitor-induced cough were 29 times more likely to develop a cough than those without this history. These factors were used to develop a model stratifying patients into 4 risk groups. In the derivation set, low-risk, average-risk, intermediate-risk, and high-risk groups had a 6\%, 9\%, 22\%, and 55\% probability of cough, respectively. In the validation set, 4\%, 14\%, 20\%, and 60\% of patients in these 4 groups developed cough, respectively. CONCLUSIONS: This model may help clinicians predict the likelihood of a particular patient developing cough from an angiotensin-converting enzyme inhibitor at the time of prescribing, and may also assist with subsequent clinical decisions.}, address = {Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.}, author = {Morimoto, T. and Gandhi, T. K. and Fiskio, J. M. and Seger, A. C. and So, J. W. and Cook, E. F. and Fukui, T. and Bates, D. W.}, citeulike-article-id = {563972}, citeulike-linkout-0 = {http://dx.doi.org/10.1111/j.1525-1497.2004.30016.x}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/15209608}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=15209608}, doi = {10.1111/j.1525-1497.2004.30016.x}, issn = {0884-8734}, journal = {J Gen Intern Med}, keywords = {acei, clinicalpredictionrule, cough}, month = {June}, number = {6}, pages = {684--691}, posted-at = {2006-03-26 16:13:13}, priority = {3}, title = {Development and validation of a clinical prediction rule for angiotensin-converting enzyme inhibitor-induced cough.}, url = {http://dx.doi.org/10.1111/j.1525-1497.2004.30016.x}, volume = {19}, year = {2004} }

TY - JOUR ID - citeulike:563972 L3 - citeulike-article-id:563972 N2 - BACKGROUND: Angiotensin-converting enzyme inhibitors are effective for many cardiovascular diseases and are widely prescribed, but cough sometimes necessitates their withdrawal. OBJECTIVE: To develop and validate a model that predicts, by using information available at first prescription, whether a patient will develop cough within 6 months. DESIGN: Retrospective cohort study with derivation and validation sets. SETTING: Outpatient clinics affiliated with an urban tertiary care hospital. PATIENTS: Clinical data were collected from electronic charts. The derivation set included 1125 patients and the validation set included 567 patients. INTERVENTIONS: None. MEASUREMENTS: Angiotensin-converting enzyme inhibitor-induced cough assessed by predetermined criteria. RESULTS: In the total cohort, 12% of patients developed angiotensin-converting enzyme inhibitor-induced cough. Independent multivariate predictors of cough were older age, female gender, non-African American (with East Asian having highest risk), no history of previous angiotensin-converting enzyme inhibitor use, and history of cough due to another angiotensin-converting enzyme inhibitor. Patients with a history of angiotensin-converting enzyme inhibitor-induced cough were 29 times more likely to develop a cough than those without this history. These factors were used to develop a model stratifying patients into 4 risk groups. In the derivation set, low-risk, average-risk, intermediate-risk, and high-risk groups had a 6%, 9%, 22%, and 55% probability of cough, respectively. In the validation set, 4%, 14%, 20%, and 60% of patients in these 4 groups developed cough, respectively. CONCLUSIONS: This model may help clinicians predict the likelihood of a particular patient developing cough from an angiotensin-converting enzyme inhibitor at the time of prescribing, and may also assist with subsequent clinical decisions. IS - 6 JF - J Gen Intern Med SN - 0884-8734 AD - Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. EP - 691 TI - Development and validation of a clinical prediction rule for angiotensin-converting enzyme inhibitor-induced cough. VL - 19 SP - 684 KW - acei KW - clinicalpredictionrule KW - cough AU - Morimoto, T AU - Gandhi, TK AU - Fiskio, JM AU - Seger, AC AU - So, JW AU - Cook, EF AU - Fukui, T AU - Bates, DW PY - 2004/06// UR - http://dx.doi.org/10.1111/j.1525-1497.2004.30016.x ER -