Development and validation of a Clinical prediction rule for angiotensin-converting enzyme inhibitor-induced cough

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 1,125 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.

[1]  David W. Bates,et al.  Position Paper: A Proposal for Electronic Medical Records in U.S. Primary Care , 2003, J. Am. Medical Informatics Assoc..

[2]  D. Cherry,et al.  National Ambulatory Medical Care Survey: 2000 summary. , 2002, Advance data.

[3]  A. Halkin,et al.  Potential indications for angiotensin-converting enzyme inhibitors in atherosclerotic vascular disease. , 2002, The American journal of medicine.

[4]  I. Alhaddad,et al.  A remarkable medical story: benefits of angiotensin-converting enzyme inhibitors in cardiac patients. , 2001, Journal of the American College of Cardiology.

[5]  F. Messerli,et al.  Angiotensin II receptor blockers: equal or preferred substitutes for ACE inhibitors? , 2000, Archives of internal medicine.

[6]  A. A. Ajayi,et al.  Angioedema and cough in Nigerian patients receiving ACE inhibitors. , 2000, British journal of clinical pharmacology.

[7]  A. Tenenbaum,et al.  Intermediate but not low doses of aspirin can suppress angiotensin-converting enzyme inhibitor-induced cough. , 2000, American journal of hypertension.

[8]  J. Tsai,et al.  Severe nonproductive cough and cough-induced stress urinary incontinence in diabetic postmenopausal women treated with ACE inhibitor. , 2000, Diabetes care.

[9]  E. Cook,et al.  Drug complications in outpatients , 2000, Journal of general internal medicine.

[10]  Lucila Ohno-Machado,et al.  Using electronic data to predict the probability of true bacteremia from positive blood cultures , 2000, AMIA.

[11]  P. Malini,et al.  ACE inhibitor-induced cough in hypertensive type 2 diabetic patients. , 1999, Diabetes care.

[12]  R. Raschke,et al.  A computer alert system to prevent injury from adverse drug events: development and evaluation in a community teaching hospital. , 1998, JAMA.

[13]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[14]  James E. Calvin,et al.  Understanding articles describing clinical prediction tools , 1998 .

[15]  C Speirs,et al.  Perindopril postmarketing surveillance: a 12 month study in 47,351 hypertensive patients. , 1998, British journal of clinical pharmacology.

[16]  R. Irwin,et al.  From a prospective study of chronic cough: diagnostic and therapeutic aspects in older adults. , 1998, Archives of internal medicine.

[17]  T. Ishimitsu,et al.  Long-term evaluation of combined antihypertensive therapy with lisinopril and a thiazide diuretic in patients with essential hypertension. , 1997, Japanese heart journal.

[18]  A. Knox,et al.  Tackling ACE inhibitor cough , 1997, The Lancet.

[19]  C D Naylor,et al.  Clinical prediction rules. , 1997, Journal of clinical epidemiology.

[20]  A. Laupacis,et al.  Clinical prediction rules. A review and suggested modifications of methodological standards. , 1997, JAMA.

[21]  W. Keane,et al.  The long-term tolerability of enalapril in hypertensive patients with renal impairment. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[22]  W. Elliott.  Higher incidence of discontinuation of angiotensin converting enzyme inhibitors due to cough in black subjects , 1996, Clinical pharmacology and therapeutics.

[23]  E F Cook,et al.  Prediction of the need for intensive care in patients who come to emergency departments with acute chest pain. , 1996, The New England journal of medicine.

[24]  M B Weiss,et al.  Adverse effects of enalapril in the Studies of Left Ventricular Dysfunction (SOLVD). SOLVD Investigators. , 1996, American heart journal.

[25]  R. Norris,et al.  Racial difference in incidence of cough with angiotensin-converting enzyme inhibitors (a tale of two cities). , 1995, The American journal of cardiology.

[26]  S. Tretli,et al.  Female preponderance for lisinopril-induced cough in hypertension. , 1994, American journal of hypertension.

[27]  J. Imbs,et al.  Cough and ACE inhibitors , 1993, The Lancet.

[28]  H. Black,et al.  Cough and ACE inhibitors. , 1992, Archives of internal medicine.

[29]  W. Hall,et al.  Cough and Angioneurotic Edema Associated with Angiotensin-Converting Enzyme Inhibitor Therapy , 1992, Annals of Internal Medicine.

[30]  C. Tinelli,et al.  Effects of nifedipine and indomethacin on cough induced by angiotensin-converting enzyme inhibitors: a double-blind, randomized, cross-over study. , 1992, Journal of cardiovascular pharmacology.

[31]  R. Ferrari,et al.  Protection of the Ischemic Myocardium by the Converting-Enzyme Inhibitor Zofenopril: Insight Into Its Mechanism of Action , 1992, Journal of cardiovascular pharmacology.

[32]  D W Bates,et al.  Rapid classification of positive blood cultures. Prospective validation of a multivariate algorithm. , 1992, JAMA.

[33]  M. Young,et al.  Angiotensin-converting enzyme inhibitors and cough. Prevalence in an outpatient medical clinic population. , 1991, Chest.

[34]  A. Richards,et al.  Effect of sulindac on angiotensin converting enzyme inhibitor-induced cough: randomised placebo-controlled double-blind cross-over study. , 1989, Journal of human hypertension.

[35]  E F Cook,et al.  A computer protocol to predict myocardial infarction in emergency department patients with chest pain. , 1988, The New England journal of medicine.

[36]  C. Metz.  Basic principles of ROC analysis. , 1978, Seminars in nuclear medicine.