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. 2004 Jun;19(6):684-91.
doi: 10.1111/j.1525-1497.2004.30016.x.

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

Takeshi Morimoto  1 , Tejal K Gandhi, Julie M Fiskio, Andrew C Seger, Joseph W So, E Francis Cook, Tsuguya Fukui, David W Bates
Affiliations

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

Takeshi Morimoto et al. J Gen Intern Med. 2004 Jun.

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.

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Figures

FIGURE 1
FIGURE 1
Receiver-operating characteristic (ROC) curves for ACE inhibitor-induced cough. The area under the curve was 0.71 ± 0.03 for the derivation set, and 0.68 ± 0.03 for the vali-dation set. The difference was not statistically significant (P= .4). The straight dashed diagonal line represents a test of no discriminative ability.
FIGURE 2.
FIGURE 2.
Observed versus predicted probability of ACE inhibitor-induced cough. Results were obtained by stratifying patients into 8 categories by level of risk. Derivation and validation sets were combined.
FIGURE 3.
FIGURE 3.
Observed versus predicted incidence of ACE inhibitor-induced cough. Scatterplot allowing a visual assessment of the linearity of increasing event rates across risk groups. The straight dashed diagonal line represents perfect calibration and deviations from this line represent over- and underprediction of actual risk.
See this image and copyright information in PMC

Comment in

  • The place for ACE inhibitors.
    Petty BG. Petty BG. J Gen Intern Med. 2004 Jun;19(6):710-1. doi: 10.1111/j.1525-1497.2004.40402.x. J Gen Intern Med. 2004. PMID: 15209612 Free PMC article. No abstract available.

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