sion models were performed using the propensity scorematched cohorts. In these analyses, treatment with highdose ACE inhibitors and ARBs reduced mortality and CHF readmissions more than the medium-and low-dose treatments combined (Figure) . Comment. To our knowledge, this is the first study to estimate the effect of different doses of ACE inhibitors and ARBs on all-cause mortality and CHF readmission in patients 65 years or older with a first CHF admission. Unlike clinical trials, our study

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... uded a representative sample of unselected patients with CHF and reflects real-world clinical practice. We demonstrated that, of over 43 000 patients with CHF, approximately onethird were prescribed low doses of ACE inhibitors or ARBs. Low-dose users had significantly greater all-cause mortality and CHF readmissions. Both ACE inhibitors and ARBs decreased mortality and the composite end point in a dose-dependent manner, with high-dose users having the best outcome. However, ACE inhibitors were more effective than ARBs at reducing the composite end point. Our results demonstrate that target doses of ACE inhibitors or ARBs are reached in only one-third of patients with CHF. Physicians should strive, whenever possible, to treat patients with CHF with high doses of ACE inhibitors or ARBs to improve outcomes.