title: Heart failure mortality among older Medicare beneficiaries: association with left ventricular function evaluation and angiotensin-converting enzyme inhibitor use.
abstract: BACKGROUND
  Left ventricular function evaluation and angiotensin-converting enzyme (ACE) inhibitor use are the two basic indicators of heart failure quality of care. In this retrospective follow-up study, we analyzed the association between these two quality indicators and mortality in elderly hospitalized heart failure patients.
  
  
  METHODS
  The patients in our study were older Alabama Medicare beneficiaries discharged with a diagnosis of heart failure in 1994. Cox regression analyses, adjusted for various patient and care characteristics, were performed to estimate the overall mortality rate.
  
  
  RESULTS
  The mean age of the 1,090 patients in our study was 79+/-7.5 years. Both left ventricular function evaluation (hazard ratio, 0.83; 95% confidence interval, 0.705-0.976) and ACE inhibitor use (hazard ratio, 0.77; 95% confidence interval, 0.655-0.905) were associated with a lower 3-year mortality rate. Adjustment for various patient and care characteristics did not alter these associations.
  
  
  CONCLUSIONS
  Left ventricular function evaluation and ACE inhibitor use were each associated with increased survival time in older Medicare beneficiaries with heart failure.
authors.affiliation: Division of Gerontology and Geriatric Medicine, Department of Medicine, Center for Aging, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA. aahmed@uab.edu
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
authors.forename: Richard
authors.initials: R
authors.lastname: Maisiak
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.forename: James F
authors.initials: JF
authors.lastname: DeLong
authors.forename: Robert
authors.initials: R
authors.lastname: Farmer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors