Jenny S W Lee1, Pui Yuk Chui2, Hon Ming Ma3, Tung Wai Auyeung4, Carolyn Kng5, Thomas Law6, Louisa K Y Ng7, Kui Fu Tam8, Wing Han Tang9, Becky Y T Chan10, Michael C F Tong6, Ka Tak Wong11, Yuen Har Yuen12, Ka Lok Yuk3, Timothy Kwok13. 1. The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine, Alice Ho Mui Ming Nethersole Hospital, Tai Po; Department of Medicine and Geriatrics, Shatin Hospital, Shatin. Electronic address: jennylee@cuhk.edu.hk. 2. Department of Medicine and Geriatrics, Tai Po Hospital, Tai Po. 3. Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin. 4. The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Geriatrics, Pok Oi Hospital, Yuen Long. 5. Department of Medicine and Geriatrics, Ruttonjee Hospital, Wanchai. 6. Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China. 7. Department of Special Education and Counselling, The Hong Kong Institute of Education, Hong Kong SAR, China. 8. Department of Medicine, Buddhist Hospital, Kowloon. 9. Department of Medicine and Geriatrics, Princess Margaret Hospital, Kwai Chung. 10. Speech Therapy Department, Prince of Wales Hospital, Shatin. 11. Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. 12. Speech Therapy Department, Shatin Hospital, Shatin. 13. The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin. Electronic address: tkwok@cuhk.edu.hk.
Abstract
OBJECTIVE: To examine if angiotensin converting enzyme inhibitor reduces the risk of pneumonia in older patients on tube-feeding because of dysphagia from cerebrovascular diseases. DESIGN: Randomized placebo-controlled trial. SETTING: Acute and subacute geriatrics units, speech therapists' clinic, and nursing home. PARTICIPANTS: Older patients on tube-feeding for >2 weeks because of dysphagia secondary to cerebrovascular diseases. INTERVENTION: Participants were randomized to lisinopril 2.5 mg or placebo once daily for 26 weeks. MEASUREMENTS: Participants were followed up at weeks 12 and 26. The primary outcome was the incidence rate of pneumonia as determined by pneumonic changes on x-ray and clinical criteria. The secondary outcomes were mortality rate and swallowing ability as defined by the Royal Brisbane Hospital Outcome Measure for Swallowing at week 12. RESULTS: A total of 93 older patients were randomized. In interim analysis, 71 completed the trial, whereas 15 had dropped out. Among those who had completed the trial, odds ratio (OR) for death was significantly higher in the intervention group (unadjusted OR 2.94, P = .030; fully adjusted OR 7.79, P = .018). There was no difference in the incidence of pneumonia or fatal pneumonia in the 2 groups. The intervention group had a marginally better swallowing function at week 12 (Royal Brisbane Hospital Outcome Measure for Swallowing score: 4.2 ± 1.5 in intervention group, 3.5 ± 1.5 in placebo group, P = .053). As a result of the interim finding on mortality, the trial was prematurely terminated with 7 participants still in the trial. CONCLUSIONS: Low dose lisinopril given to older tube-fed patients with neurologic dysphagia resulted in increased mortality, although swallowing function showed marginal improvement. ACE inhibitors did not prevent pneumonia in older patients with neurologic dysphagia and might increase mortality.
RCT Entities:
OBJECTIVE: To examine if angiotensin converting enzyme inhibitor reduces the risk of pneumonia in older patients on tube-feeding because of dysphagia from cerebrovascular diseases. DESIGN: Randomized placebo-controlled trial. SETTING: Acute and subacute geriatrics units, speech therapists' clinic, and nursing home. PARTICIPANTS: Older patients on tube-feeding for >2 weeks because of dysphagia secondary to cerebrovascular diseases. INTERVENTION: Participants were randomized to lisinopril 2.5 mg or placebo once daily for 26 weeks. MEASUREMENTS: Participants were followed up at weeks 12 and 26. The primary outcome was the incidence rate of pneumonia as determined by pneumonic changes on x-ray and clinical criteria. The secondary outcomes were mortality rate and swallowing ability as defined by the Royal Brisbane Hospital Outcome Measure for Swallowing at week 12. RESULTS: A total of 93 older patients were randomized. In interim analysis, 71 completed the trial, whereas 15 had dropped out. Among those who had completed the trial, odds ratio (OR) for death was significantly higher in the intervention group (unadjusted OR 2.94, P = .030; fully adjusted OR 7.79, P = .018). There was no difference in the incidence of pneumonia or fatal pneumonia in the 2 groups. The intervention group had a marginally better swallowing function at week 12 (Royal Brisbane Hospital Outcome Measure for Swallowing score: 4.2 ± 1.5 in intervention group, 3.5 ± 1.5 in placebo group, P = .053). As a result of the interim finding on mortality, the trial was prematurely terminated with 7 participants still in the trial. CONCLUSIONS: Low dose lisinopril given to older tube-fed patients with neurologic dysphagia resulted in increased mortality, although swallowing function showed marginal improvement. ACE inhibitors did not prevent pneumonia in older patients with neurologic dysphagia and might increase mortality.
Authors: Thomas P Zonneveld; Edo Richard; Mervyn DI Vergouwen; Paul J Nederkoorn; Rob de Haan; Yvo Bwem Roos; Nyika D Kruyt Journal: Cochrane Database Syst Rev Date: 2018-07-19
Authors: Lisa J Woodhouse; Polly Scutt; Shaheen Hamdy; David G Smithard; David L Cohen; Christine Roffe; Daniel Bereczki; Eivind Berge; Christopher F Bladin; Valeria Caso; Hanne K Christensen; Rónán Collins; Anna Czlonkowska; Asita de Silva; Anwar Etribi; Ann-Charlotte Laska; George Ntaios; Serefnur Ozturk; Stephen J Phillips; Kameshwar Prasad; Szabolcs Szatmari; Nikola Sprigg; Philip M Bath Journal: Transl Stroke Res Date: 2017-08-02 Impact factor: 6.829