Randomized controlled intervention in cardiovascular drug treatment in nursing homes.
OBJECTIVE
To study drug treatment of patients with cardiovascular diseases (heart failure, post-myocardial infarction, angina pectoris, hypertonia or cardiac valvular disease) in nursing homes and assess effect of medication advice.


METHODS
The patients were randomized to an intervention or control group. Medication reviews were made by one specialist in clinical pharmacology and one in cardiology. Symptoms related to heart failure or adverse reactions to cardiovascular drugs were recorded using a questionnaire. Quality of life and activities of daily living (ADL) were assessed and follow-ups performed after 2 weeks and 3 months. Outcome measures were changes of drug therapy and the global scores computed from symptoms scales.


RESULTS
Eighty patients were randomized. They had a mean age of 87 years and their average number of drugs was 9.6. Changed drug therapy was suggested in 40 patients and the advice was followed by the responsible physicians in 19 patients. The physicians mostly followed advice for changed furosemide therapy but not for introducing an ACE-inhibitor, probably due to uncertain diagnosis and need for follow-up after initiation of such therapy. No significant changes from baseline to later follow-up were found in the mean total scores of any questionnaire.


CONCLUSIONS
Intervention did not affect cardiovascular symptoms. Drug revisions should involve more than one class of drugs in order to be cost-effective.
Ulfvarson
Johanna
J
Department of Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Stockholm Söder Hospital, Institution for Nursing, Sweden.
Adami
Johanna
J
Ullman
Bengt
B
Wredling
Regina
R
Reilly
Marie
M
von Bahr
Christer
C
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006299:Health Services for the Aged; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008485:Medical Audit; D009735:Nursing Homes; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D013548:Sweden; D016896:Treatment Outcome
D002317:Cardiovascular Agents