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J Gen Intern Med. 2004 Jun;19(6):684-91.

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

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1
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.

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.

Comment in

PMID:
15209608
PMCID:
PMC1492376
DOI:
10.1111/j.1525-1497.2004.30016.x
[Indexed for MEDLINE]
Free PMC Article
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