Surveys - VIN

Current Results for VIN Survey, ACE Inhibitors
1. Do you prescribe or dispense angiotensin converting enzyme (ACE) inhibitors to treat dogs in your practice?
a. Yes - Continue to Question 2
94.8 % (220 of 232)
b. No
4.7 % (11 of 232)
Not Answered
0.4 % (1 of 232)

2. Which of the following best describes how frequently you prescribe or dispense an ACE inhibitor to begin ACEI treatment in a dog?
a. one or a few times per day
5.6 % (13 of 232)
b. one or a few times per week
17.2 % (40 of 232)
c. one or a few times per month
52.1 % (121 of 232)
d. one or a few times per year
20.2 % (47 of 232)
Not Answered
4.7 % (11 of 232)

3. Which ACE inhibitor do you use most frequently in dogs?
a. enalapril
82.3 % (191 of 232)
b. captopril
0.4 % (1 of 232)
c. lisinopril
0.8 % (2 of 232)
d. benazepril
9.9 % (23 of 232)
e. ramipril
2.1 % (5 of 232)
f. other
0.4 % (1 of 232)
Not Answered
3.8 % (9 of 232)

4. In what type or types of canine patient do you use ACE inhibitors? Check all that apply.
a. Those with mitral regurgitation
90.5 % (210 of 232)
b. Those with dilated cardiomyopathy
61.2 % (142 of 232)
c. Those with other forms of heart disease
50.8 % (118 of 232)
d. Those with glomerular disease
42.2 % (98 of 232)
e. Those with other forms of renal disease
13.3 % (31 of 232)
f. Those with systemic hypertension
43.5 % (101 of 232)
g. Other
0.8 % (2 of 232)

5. In what type of canine patient do you use ACE inhibitors MOST FREQUENTLY?
a. Those with mitral regurgitation
74.1 % (172 of 232)
b. Those with dilated cardiomyopathy
11.6 % (27 of 232)
c. Those with other forms of heart disease
3 % (7 of 232)
d. Those with glomerular disease
3.4 % (8 of 232)
e. Those with other forms of renal disease
0.4 % (1 of 232)
f. Those with systemic hypertension
2.5 % (6 of 232)
g. Other
0 % (0 of 232)
Not Answered
4.7 % (11 of 232)

6. How severe does cardiac disease need to be for you to consider ACE inhibitor therapy?
a. The dog must be in heart failure (i.e., must have pulmonary edema, pleural effusion or ascites secondary to severe heart disease)
27.1 % (63 of 232)
b. The dog must have at least moderate cardiac disease (e.g., at least moderate left atrial enlargement in a dog with mitral regurgitation)
56.4 % (131 of 232)
c. The dog must at least have evidence of cardiac disease (e.g., at least a heart murmur in a dog with mitral regurgitation)
10.7 % (25 of 232)
Not Answered
5.6 % (13 of 232)

7. On a scale of 1 to 5 (1 = not at all effective, 5 = very effective) how effective do you believe ACE inhibitors to be for slowing the progression of heart disease to heart failure in dogs with mitral regurgitation?
a. 1 = not at all effective
10.7 % (25 of 232)
b. 2
14.2 % (33 of 232)
c. 3 = somewhat effective
37 % (86 of 232)
d. 4
22.4 % (52 of 232)
e. 5 = very effective
5.6 % (13 of 232)
f. No opinion
5.1 % (12 of 232)
Not Answered
4.7 % (11 of 232)

8. On a scale of 1 to 5 (1 = not at all effective, 5 = very effective) how effective do you believe ACE inhibitors to be for slowing the progression of heart disease to heart failure in dogs with dilated cardiomyopathy?
a. 1 = not at all effective
12 % (28 of 232)
b. 2
21.9 % (51 of 232)
c. 3 = somewhat effective
29.3 % (68 of 232)
d. 4
9.4 % (22 of 232)
e. 5 = very effective
0.8 % (2 of 232)
f. No opinion
20.6 % (48 of 232)
Not Answered
5.6 % (13 of 232)

9. On a scale of 1 to 5 (1 = not at all effective, 5 = very effective) how effective do you believe ACE inhibitors to be for slowing the progression of heart disease to heart failure in dogs with other forms of heart disease?
a. 1 = not at all effective
13.7 % (32 of 232)
b. 2
17.2 % (40 of 232)
c. 3 = somewhat effective
32.3 % (75 of 232)
d. 4
5.6 % (13 of 232)
e. 5 = very effective
0.4 % (1 of 232)
f. No opinion
23.2 % (54 of 232)
Not Answered
7.3 % (17 of 232)

10. On a scale of 1 to 5 (1 = not at all effective, 5 = very effective) how effective do you believe ACE inhibitors to be in the acute (emergency) management of congestive heart failure in dogs?
a. 1 = not at all effective
25.8 % (60 of 232)
b. 2
29.7 % (69 of 232)
c. 3 = somewhat effective
23.2 % (54 of 232)
d. 4
6.4 % (15 of 232)
e. 5 = very effective
3.4 % (8 of 232)
f. No opinion
5.1 % (12 of 232)
Not Answered
6 % (14 of 232)

11. On a scale of 1 to 5 (1 = not at all effective, 5 = very effective) how effective do you believe ACE inhibitors to be in the chronic management of congestive heart failure in dogs?
a. 1 = not at all effective
0 % (0 of 232)
b. 2
3.8 % (9 of 232)
c. 3 = somewhat effective
26.2 % (61 of 232)
d. 4
39.2 % (91 of 232)
e. 5 = very effective
25 % (58 of 232)
f. No opinion
0 % (0 of 232)
Not Answered
5.6 % (13 of 232)

12. True or False: ACE inhibitors alone are effective in preventing the onset of congestive heart failure in dogs with mitral regurgitation.
a. True
11.2 % (26 of 232)
b. False
67.2 % (156 of 232)
c. I do not know
16.8 % (39 of 232)
Not Answered
4.7 % (11 of 232)

13. True or False: ACE inhibitors are most beneficial when given along with a diuretic such as furosemide when treating congestive heart failure in dogs with heart disease.
a. True
85.3 % (198 of 232)
b. False
6.8 % (16 of 232)
c. I do not know
3 % (7 of 232)
Not Answered
4.7 % (11 of 232)

14. Who or what has most influenced the way you use ACE inhibitors?
a. VIN
22.8 % (53 of 232)
b. A veterinary cardiologist or a number of veterinary cardiologists
52.5 % (122 of 232)
c. A specialist other than a veterinary cardiologist or someone you consider to be an expert on the subject
9 % (21 of 232)
d. Another veterinarian or veterinarians in your practice
2.1 % (5 of 232)
e. Another veterinarian or veterinarians not in your practice
1.7 % (4 of 232)
f. A pharmaceutical representative
0.4 % (1 of 232)
g. Advertising in veterinary journals
0.4 % (1 of 232)
h. Other
5.1 % (12 of 232)
Not Answered
5.6 % (13 of 232)

15. Who or what has least influenced the way you use ACE inhibitors?
a. VIN
1.7 % (4 of 232)
b. A veterinary cardiologist or a number of veterinary cardiologists
1.2 % (3 of 232)
c. A specialist other than a veterinary cardiologist or someone you consider to be an expert on the subject
0.4 % (1 of 232)
d. Another veterinarian or veterinarians in your practice
3 % (7 of 232)
e. Another veterinarian or veterinarians not in your practice
3.4 % (8 of 232)
f. A pharmaceutical representative
39.2 % (91 of 232)
g. Advertising in veterinary journals
43.9 % (102 of 232)
h. Other
1.7 % (4 of 232)
Not Answered
5.1 % (12 of 232)

16. How would you rate the degree to which pharmaceutical representatives have influenced the way you use ACE inhibitors in your practice?
a. high
0.4 % (1 of 232)
b. moderately high
0 % (0 of 232)
c. moderately
5.6 % (13 of 232)
d. somewhat
5.6 % (13 of 232)
e. very little
32.7 % (76 of 232)
f. not at all
50.8 % (118 of 232)
Not Answered
4.7 % (11 of 232)

17. What form(s) of information about the use of ACE inhibitors in your practice has recently been provided to you by pharmaceutical representatives? Check all that apply.
a. Verbal information (i.e., casual mention) about ACE inhibitors
17.6 % (41 of 232)
b. Verbal promotion (i.e., more than casual mention) of ACE inhibitors
15.9 % (37 of 232)
c. Company literature regarding ACE inhibitors
36.2 % (84 of 232)
d. Scientific journal articles regarding ACE inhibitors
18.5 % (43 of 232)
e. Book chapters regarding ACE inhibitors
7.7 % (18 of 232)

18. Referring to question 17 above, has the form of information provided to you by pharmaceutical representatives changed over the past 10 years (or -- for you youngsters -- as long as you have been practicing)?
a. Yes
32.7 % (76 of 232)
b. No
45.6 % (106 of 232)
Not Answered
21.5 % (50 of 232)

19. If you responded yes to question 18, what forms of information were provided more frequently in the past? Check all that apply.
a. Verbal information about ACE inhibitors
16.3 % (38 of 232)
b. Verbal promotion of ACE inhibitors
19.8 % (46 of 232)
c. Company literature regarding ACE inhibitors
19.3 % (45 of 232)
d. Scientific journal articles regarding ACE inhibitors
10.7 % (25 of 232)
e. Book chapters regarding ACE inhibitors
2.5 % (6 of 232)
f. No change � the mix seems about the same
8.6 % (20 of 232)

20. If you responded yes to question 18, what form(s) of information were provided less frequently in the past? Check all that apply.
a. Verbal information about ACE inhibitors
3.8 % (9 of 232)
b. Verbal promotion of ACE inhibitors
4.3 % (10 of 232)
c. Company literature regarding ACE inhibitors
7.7 % (18 of 232)
d. Scientific journal articles regarding ACE inhibitors
14.6 % (34 of 232)
e. Book chapters regarding ACE inhibitors
8.6 % (20 of 232)
f. No change � the mix seems about the same
8.6 % (20 of 232)

21. When a pharmaceutical representative has verbally communicated with you regarding the use of ACE inhibitors, what are you currently most commonly told with regard to the indication(s) for prescribing ACE inhibitors?
a. ACE inhibitors should be reserved for use only in dogs that are in heart failure (i.e., those that have pulmonary edema, pleural effusion or ascites secondary to severe heart disease present).
2.5 % (6 of 232)
b. ACE inhibitors should be used in all dogs with moderate to severe heart disease (e.g., those with moderate to severe left atrial enlargement due to mitral regurgitation) and in those that are in heart failure.
21.1 % (49 of 232)
c. ACE inhibitors should be started at the time a dog is diagnosed with heart disease (e.g., a heart murmur due to mitral regurgitation) and should be continued from then on.
33.1 % (77 of 232)
Not Answered
43.1 % (100 of 232)

22. Referring to question 21 above, has the information you have received from pharmaceutical representatives regarding the indications for ACE inhibitors changed in the past 10 years (or -- for you youngsters -- as long as you have been practicing)?
a. Yes
19.8 % (46 of 232)
b. No
44.3 % (103 of 232)
Not Answered
35.7 % (83 of 232)

23. If you responded yes to question 22, what has changed?
a. I am now told that I should only administer an ACE inhibitor to dogs that are in heart failure (i.e., those with pulmonary edema, pleural effusion, or ascites secondary to severe heart disease) whereas I used to be told that any dog with heart disease should receive an ACE inhibitor.
3 % (7 of 232)
b. I am told that I should now only administer ACE inhibitors to dogs in heart failure and those that have moderate to severe left atrial enlargement due to mitral regurgitation whereas I used to be told that any dog with heart disease should receive an ACE inhibitor (e.g., any dog with a heart murmur).
9.4 % (22 of 232)
c. I am now told that I should give ACE inhibitors to any dog with heart disease (e.g., any dog with a heart murmur) whereas I used to be told to administer them only to dogs that are in heart failure or to dogs that had moderate to severe disease (e.g., moderate to severe left atrial enlargement in a dog with mitral regurgitation).
7.3 % (17 of 232)
d. There has been no change.
7.7 % (18 of 232)
Not Answered
72.4 % (168 of 232)

24. Comments on ACE inhibitors or this Survey.
(1) another question that should have been asked is does your ace inhibitor seem to be most effective when accompanied by digoxin. Do you start ace inhibitors at the time you start dig, before dig, or a few days after starting dig. Do you use furosemide with this combination? Response?
(2) Difficult for me, an ER and Critical Care type, to answer re: pharmaceutical reps. Seems they don't call on us much. We have a large buying group in British Columbia, so most of the "scientific" info is distributed via glossy mail-outs. e.g., Fortecor Suann
(3) Have not spoken to a pharmaceutical rep about ACE inhibitors for > 5 years.
(4) Havent gotten too much info about acei's from rep but initial impression was to use at first sign of changes radiographically of heart and vessels ie atrial enlargement etc but not wait until overt failure state and that this would prolong the disease free interval...base on human lit.Subsequently some prospective studies said otherwise that they didnt prolong life or extend the disease free interval so we have backed off using them early.
(5) Having an 'Other' option for question 15 is a bit nonsensical. I guess I have been least influenced by the opinions of my barber's grandmother on ACE inhibitors....should I therefore have checked 'Other'? :)
(6) Honestly I have learned through VIN that ACE inhibitors are not suppose to be effective until the onset of congestive heart failure. However, since it is now so inexpensive and my own personal survey n=1 I cannot feel good about not using an Ace Inhibitor in a dog with mitral regurgitation. My own dog with a murmur of 5/6 and a whopping left atrium has been plugging along fine for the past 6 years with Enalapril. He is now 15. Although he is not in heart failure I will not stop the enalapril until he is gone.
(7) I am confused about the use of ACE inhibitors and renal dysfunction. I was traditionally taught (not a youngster) to use with caution in renally impaired dogs and to monitor creat.. and BUN. Now, pharm. reps are saying renal failure is an indication for use. Attended a talk 2-3 years ago by Dr. Mike O'Grady who questioned this. I believe him.
(8) I am reluctant in some dogs with pre-existing azotemia to use ACE inhibitors. In such cases... I have been inclined to use spirolactone and furosemide instead... Wrong or not...see less azotemia with this approach.
(9) I declined to answer any questions regarding pharmaceutical reps, because I do not allow them in my practice and have no personal contact with them directly. When I want something, I call the company and order it. Other than that, I do not want them in my clinic. If for some reason they are in my clinic, they are there to speak to my practice mananger, and not myself or any other DVMs.
(10) I do not talk to drug reps
(11) I do relief practice and I believe I see very many dogs with mitral murmurs being prescribed these drugs too early.
(12) I find them somewhat effective, but it is difficult to really measure since we do not do many echos on non heartfailure patients.
(13) I have found them to be very beneficial in the stabilization of congestive heart failure patients. In my hands it has made a significant difference in the longevity of cases that seemed hopeless.
(14) I have heard nothing of consequense from reps since the introduction of Enacard.
(15) I have NEVER spoken to a pharmaceutical rep about ACE inhibitors. Don't care to, either. Also don't read journals and therefore do not respond to advertisements.
(16) I have not been approached recently about ACEI. I did not answer this question because of that. Much of the info comes from CE. Sales reps know I do alot of CE including VIN and am just as likely to quote literature as they are.Thank you for your survey. Have we done a survey like this on Lymes dz. The confusion about this dz is phenomenal and mostly non-scientific! A pet peeve of mine. Linda
(17) I have not communicated directly with any reps on this subject for years, so really can't answer many of the questions. I like ACE I most for long-term management of CHF cases, alone or sometimes in conjunction with Lasix, based on my own observations that the dogs feel better, are more active, and don't suffer the diuretic effects of Lasix which leads to improved compliance and tolerance among pet owners.
(18) I have not spoken to a pharm rep about AECI in many years (5+).
(19) I rarely see a Merial rep, and I have not been spoken to about enalapril for years. I think that ACE inhibitors are a valuable ASSET to managing heart dz, but alone are not horribly impressive.
(20) I rarely see company representatives
(21) I really can't remember any sales reps except maybe at meetings when enacard was around. Now that it is generic, they don't boterh to educate! (No money for them in it???)
(22) I work in emergency medicine only which influences the way I use and prescribe these drugs. I also rarely talk to pharmaceutical reps.
(23) I've never had a pharmaceutical rep discuss ACE inhibitors with me...
(24) If ACE nihibitors are beneficial for both failing hearts and to diseased kidneys, why can they not help solve the common ICU dilemma of treating the heart versus treating CRF first? Are they not actually renotoxic, at least when co-administered with diuretics?
(25) In response to the survey itself and the questions about the drug reps - I really haven't had much interaction/feedback from them about the ACE inhibitors. I don't really encourage information from them either since I look for new information from cardiologists/specialists and even VIN before I listen to the reps. In addition, my office manager screens most of the new drug information and does run all the new information by the doctors but, again, I don't pay much heed to sales pitches.
(26) it becomes more and more difficult to obtain objective information.
(27) Many practitioners I know are putting asymptomatic dogs with heart murmurs on ACE inhibitors upon diagnosis of the murmur, and then practically forgetting about them for years! I would like to see the pharmaceutical companies put more emphasis on recommended pretreatment workups (bloodwork, u/a, rads, bp, heart/resp. rate) and routine followup parameters. If these patients are really so easy to treat and forget, maybe the ACE inhibitor was not really needed yet?!!
(28) Most of the changes regarding use of ACE inhibitors has come from certain cardiologists. There seems to be a growing number who advocate use of ACE inhibitors when the dog is initially diagnosed with any degree of left atrial enlargement. Others point to studies which show no increase in life span when dogs are started on ace inhibitors at that stage. The biggest change is mostly from internists who suggest that ACE inhibitors be used for dogs and cats with kidney dz (glomerular dz and chronic renal failure)
(29) My practice is limited to dentistry-so rarely initiate therapy but previously used the ACEI's vasotec w/ CHF patients prior to digoxin- some 15 yrs. back
(30) Never heard a rep talk abuot it.
(31) No doubt that ACE inhibitors are used inappropriately, but nevertheless, they are valuable drugs in selected cases and likely do no significant harm in most cases
(32) No info from a pharmaceutical rep in our practice since I can't remember when.
(33) Should be a way to respond "don't know" to some questions re: response to therapy. Since I'm not doing a controlled study how do I really know whether ACE inhibitors are effective in slowing the progression of disease in an individual dog?
(34) Some answers would differ if heart failure due to DCM was separated from that due to mitral regurgitation.
(35) The only research that I know of suggests that ACE-I do not prolong life. I used to use ACE-I more frequently and earlier in MR. In follow-ups, I felt that murmur intensity decreased, but whether it helped otherwise-don't know.I use it primarily where there's documented incr LA/overcirc, plus diuretics as needed. I use it only occasionally for hypertension-more often use amlodipine. In non-MR heart disease, i will use it in selected cases that would benefit from reduced Na load and reduced afterload. I prescribe it several times yearly. Usually we have Ultrasound as well as rad workups on these guys. The pharm companies are marketing it aggressively. Hamlin recently gave a lecture touting Enalopril, sprionolactone, beta-blockers etc- a multi-pharm approach to CHF management.
(36) they work well and have good safety margin
(37) too long a survey
(38) Use of ACEi's in dogs WITH ANY SYMPTOMS of heart failure is my criterion for use...is that clearly one of the options?
(39) Very benefical drug.
(40) We have been using generic enalopril, so I haven't talked to a rep for a couple years. They really pushed hard years ago that survival was increased, but that wasn't borne out by research, same as disease progression in MI. Sorry I can't be more thorough in my survey. I don't listen to the sales pitch these days to know what it is.
(41) what the pharmacuetical company says does not always agree with scientific research, which is why they don't provide that literature and why we as veterinarians should not based our decisions on company opinion or even company research.

Front Page : Library : Survey Main

800.700.4636 | VINGRAM@vin.com | 530.756.4881 | Fax: 530.756.6035
777 W. Covell Blvd, Davis, CA 95616
Copyright Veterinary Information Network, Inc.