Underutilization of angiotensin-converting enzyme inhibitors in older patients with Q-wave anterior myocardial infarction in an academic hospital-based geriatrics practice.
OBJECTIVE
To investigate the prevalence of angiotensin-converting enzyme (ACE) inhibitors use in older persons without contraindications to ACE inhibitors and with prior Q-wave anterior myocardial infarction (MI), anterior MI with congestive heart failure (CHF), and with anterior MI and a left ventricular ejection fraction (LVEF) < or = 40% in an academic hospital-based geriatrics practice.


METHODS
A retrospective analysis of charts from all older patients seen from January 1996 through July 1997 at an academic hospital-based geriatrics practice was performed to investigate the prevalence of ACE inhibitor use in older patients with prior Q-wave anterior MI, anterior MI with CHF, and anterior MI with LVEF < or = 40% without contraindications to ACE inhibitors.


METHODS
An academic hospital-based primary care geriatrics practice staffed by fellows in a geriatrics training program and full-time faculty geriatricians.


METHODS
Ninety-six women and 65 men, mean age 82 +/- 8 years (range 65 to 96), were included in the study.


RESULTS
Of 161 patients with Q-wave anterior MI and no contraindications to ACE inhibitors, LVEF was measured in 58 patients (36%), 56 (35%) of whom were receiving ACE inhibitors. Of 45 patients with Q-wave anterior MI and CHF, 30 patients (67%) were receiving ACE inhibitors. Of 15 patients with Q-wave anterior MI and asymptomatic LVEF < or = 40%, four patients (27%) were receiving ACE inhibitors.


CONCLUSIONS
There is a marked underutilization of use of ACE inhibitors in treating older patients with Q-wave anterior MI in an academic hospital-based geriatrics practice.
Mendelson
G
G
Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York, USA.
Aronow
W S
WS
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D004363:Drug Utilization; D004562:Electrocardiography / Q000187:drug effects*; D005257:Fellowships and Scholarships; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D005853:Geriatrics / Q000193:education; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology; D006439:Hemodynamics / Q000187:drug effects; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology; D009519:New York City; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000453:epidemiology
D000806:Angiotensin-Converting Enzyme Inhibitors