Journal article
Ordering of the Serum Angiotensin-Converting Enzyme Test in Patients Receiving Angiotensin-Converting Enzyme Inhibitor Therapy: An Avoidable but Common Error
Chest, Vol.148(6), pp.1447-1453
12/2015
DOI: 10.1378/chest.15-1061
PMID: 26225637
Abstract
Serum angiotensin-converting enzyme (ACE) levels may be decreased by use of ACE inhibitor (ACEI) medication. In this study, we determined how often ACE levels were measured in patients receiving ACEI therapy.
ACE levels analyzed over a 54-month preintervention time period at an academic medical center were reviewed retrospectively for tests performed during ACEI therapy. These data were compared with a large, deidentified dataset of ACE levels measured at a national reference laboratory; in vitro studies of ACEI inhibition; and liquid chromatography time-of-flight mass spectrometry detection of lisinopril in a subset of clinical specimens.
Over a 54-month period, 1,292 patients had ACE levels measured, with 108 patients (8.4%) receiving ACEI therapy at the time of testing. ACE levels measured for patients receiving ACEI therapy were substantially lower. In general, clinical teams did not recognize a medication effect on ACE levels. Introduction of a warning prompt in the electronic health record reduced the ordering of ACE levels in patients receiving ACEIs by > 60% in a 17-month postintervention time period. The deidentified dataset of ACE levels at a reference laboratory showed a bimodal distribution, with a peak of very low ACE levels. Using liquid chromatography time-of-flight mass spectrometry, the presence of lisinopril was confirmed in a subset of specimens with low ACE activity. In vitro studies of two different ACE assays showed significant inhibition of activity at clinically relevant concentrations.
Assessment of ACE activity is often measured for patients receiving ACEIs, potentially leading to low ACE concentrations and inaccurate interpretations.
Details
- Title: Subtitle
- Ordering of the Serum Angiotensin-Converting Enzyme Test in Patients Receiving Angiotensin-Converting Enzyme Inhibitor Therapy: An Avoidable but Common Error
- Creators
- Matthew D Krasowski - Department of Pathology and the Department of Internal Medicine, University of Iowa, Iowa City, IA. Electronic address: mkrasows@healthcare.uiowa.eduJohanna Savage - Department of Pathology and the Department of Internal Medicine, University of Iowa, Iowa City, IAAlexandra Ehlers - Department of Pathology and the Department of Internal Medicine, University of Iowa, Iowa City, IAJon Maakestad - Department of Pathology and the Department of Internal Medicine, University of Iowa, Iowa City, IAGregory A Schmidt - Department of Pathology and the Department of Internal Medicine, University of Iowa, Iowa City, IASonia La'ulu - ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UTNatalie N Rasmussen - ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UTFrederick G Strathmann - ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Department of Pathology, University of Utah, Salt Lake City, UTJonathan R Genzen - ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Department of Pathology, University of Utah, Salt Lake City, UT
- Resource Type
- Journal article
- Publication Details
- Chest, Vol.148(6), pp.1447-1453
- Publisher
- United States
- DOI
- 10.1378/chest.15-1061
- PMID
- 26225637
- ISSN
- 0012-3692
- eISSN
- 1931-3543
- Language
- English
- Date published
- 12/2015
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Pathology; Internal Medicine
- Record Identifier
- 9984046908102771
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