Comparing Treatment and Outcomes for Patients with ACE-Inhibitor Induced Angioedema across MedStar Health

Recently published research from a collaborative team from across MedStar Health hospitals sought to compare patient demographics, treatment, and outcomes for Angiotensin-converting enzyme (ACE) inhibitor-induced angioedema to outcomes for patients with angioedema from other causes in our regional health-care system. ACE angioedema has not been characterized in comparison with angioedema from other causes in acute hospitalized patients.

Angioedema is the rapid or swelling of the area beneath the skin. It is normally an allergic reaction, but it can also be hereditary It tends to affect areas with loose areas of tissue, especially the face and throat, as well as the limbs and genitals.

The study “ACE inhibitor angioedema: characterization and treatment versus non-ACE angioedema in acute hospitalized patients” retrospectively compared patients admitted from the emergency department with angioedema or developed angioedema during the hospital course.   The electronic medical record data abstraction tool included demographics, etiology of angioedema, treatments, clinical outcomes, and intensive care unit (ICU) admission and intubation.

A total of 855 patient records were screened and 575 cases met the inclusion criteria of angioedema diagnosis. Of these, 297 had ACE angioedema and 278 had angioedema from other causes. Epinephrine was prescribed in 21% of ACE angioedema cases. One-third of patients in all groups were admitted to the ICU, and about 25% required intubation. Previous history of ACE inhibitor-induced angioedema was found in 63 of 278 non-ACE cause angioedema patients (23%) and in 23 (8%) in the ACE cause group. Age was significantly higher in the ACE cause group. At least 80% of cases in all groups were African American.  The current data suggest that angioedema poses a significant risk to patients regardless of the etiology, as 25% of patients required airway protection in the form of intubation.

The research concluded that ACE inhibitor-induced angioedema represented half of angioedema admissions over the study period.  The study found that physicians often prescribed medications that are known not to be effective for treating ACE-induced angioedema. This finding may be to the difficulty of making a definitive diagnosis. The study also identified that over 95% of the documented indications for ACE inhibitors were for hypertension. This finding supports consideration of alternate medications such as angiotensin receptor blockers to avoid the potential for angioedema from ACE inhibitors, especially in high-risk patients.

The study team included David S. Weisman, MD, DO; Nelly Arnouk, MD; M. Bilal Ashar, MD; Raheel Qureshi, MD; Anagha Kumar, Sameer Desale , Lyn Camire and Stephen Pineda  from MedStar Good Samaritan Hosptial, MedStar Union Memorial Hospital and MHRI.

Journal of Community Hospital Internal Medicine Perspectives, DOI:10.1080/20009666.2020.1711641