Trends in prescribing ACE-inhibitors for congestive heart failure in elderly people.
OBJECTIVE
The aim of this study was to analyze trends in the use of ACE-inhibitors in patients aged 65 and older with congestive heart failure (CHF) in the period from 1988 to 1998.


METHODS
We studied 2985 patients (mean age 79.7 +/- 7 years), hospitalized for CHF in 12 different bimonthly periods. Home therapy prior to hospitalization was assessed retrospectively, and data on in-hospital therapy and discharge prescriptions were collected prospectively.


RESULTS
Diuretics and digitalis were the most commonly used and prescribed drugs. The use of ACE-inhibitors between 1988 and 1998 increased from 13.4 to 46.7% prior to hospitalization, and from 25.8 to 59.2% as a discharge prescription. The most important factors associated with a prescription of ACE-inhibitors at discharge were previous use (OR 4.35, 95% CI=3.65-5.19), hypertension (OR 1.76, 95% CI=1.47-2.11), valvular heart diseases (OR 2.06, 95% CI=1.51-2.81) and diabetes (OR 1.58, 95% CI=1.29-1.93). Physical impairment was associated with a decreased use of ACE-inhibitors at discharge (OR 0.55, 95% CI=0.45-0.67).


CONCLUSIONS
The use of ACE-inhibitors for the treatment of CHF progressively increased both at home and in hospital wards of general medicine and geriatrics in the 10-year period studied. Nevertheless, digitalis and diuretics continue to be the most commonly prescribed drugs. A widespread educational effort is needed to increase physicians' awareness of the rationale for prescribing ACE-inhibitors for CHF patients.
Antonelli Incalzi
Raffaele
R
Medical Center on Aging, Sacro Cuore Catholic University, Roma, Italy.
Pedone
Claudio
C
Pahor
Marco
M
Onder
Graziano
G
Carbonin
P U
PU
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003625:Data Collection; D004071:Digitalis Glycosides / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004363:Drug Utilization; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000639:trends*
D000806:Angiotensin-Converting Enzyme Inhibitors; D004071:Digitalis Glycosides; D004232:Diuretics