Angiotensin-converting enzyme inhibitor use in elderly patients hospitalized with heart failure and left ventricular systolic dysfunction.
OBJECTIVE
Although angiotensin-converting enzyme (ACE) inhibitors are recommended for all patients with systolic heart failure, prior studies suggest that elderly cohorts are less likely to receive such therapy. The purpose of this study was to determine the age dependence of adherence to guideline-based medical care in hospitalized heart failure patients.


METHODS
We performed a multicenter observational cohort study including 613 patients admitted to participating hospitals with a primary diagnosis of heart failure with ejection fraction < or =40%. This cohort was divided into four age groups (group 1: <60, group 2: 60-69, group 3: 70-79, and group 4: 80 years) and adherence to guideline-based medical care was measured.


RESULTS
ACE inhibitors were administered to 83% of ideal heart failure patients, and this rate was similar for all age groups. Elderly patients received significantly lower ACE inhibitor dosages compared to their younger counterparts (168, 148, 125 and 117 mg captopril in groups 1, 2, 3, and 4, respectively, p=0.001). Lower creatinine clearance (p<0.001), prior residence in a long-term care facility (p=0.037), intolerance to ACE inhibitors (p=0.006), lower blood pressure (p=0.005), absence of a history of hypertension (p=0.005), and no prior heart failure hospitalizations within the past year (p=0.001) were found to be independent predictors of low ACE inhibitor dosing.


CONCLUSIONS
In this heart failure benchmarking project, elderly patients received guideline-based ACE inhibitor therapy at similar rates, but at lower doses, compared to their younger counterparts.
Rangaswamy
Chandhiran
C
University of Michigan, Ann Arbor, Mich., USA.
Finn
Jeannine I
JI
Koelling
Todd M
TM
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D019985:Benchmarking; D002216:Captopril / Q000627:therapeutic use*; D015331:Cohort Studies; D000075202:Contraindications; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000453:epidemiology
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D014665:Vasodilator Agents; D002216:Captopril; D003404:Creatinine