title: Utilisation of medications recommended for chronic heart failure and the relationship with annual hospitalisation duration in patients over 75 years of age. A pharmacoepidemiological study.
abstract: OBJECTIVE
  Trials in chronic heart failure (CHF) include few patients older than 75 years, who represent a large proportion of CHF patients. We evaluated the influence of age on CHF-medication use and of CHF medications on hospitalisation in patients older than 75 years.
  
  
  METHODS
  Included in our nested case-control study were 281 patients admitted in 2000 to a French teaching hospital with a main diagnosis of CHF and monitored over a 12-month period. Patient characteristics, medications at discharge, outpatient medications and hospitalisation frequency and duration were compared by means of univariate and multivariate analyses.
  
  
  RESULTS
  Patients older than 75 years (n=150) and 75 years or younger (n=131) were similar with regard to NYHA class and ejection fraction. At discharge, diuretic use was similar in the two groups, but fewer older patients were prescribed angiotensin-converting enzyme (ACE) inhibitors (48% versus 63%, P<0.01) or beta-blockers (19% versus 37%, P<0.001). During follow-up, total re-admission rate and mean number of re-admissions were similar; however, total hospitalisation duration was greater in patients older than 75 years (38+/-77 days) than in those 75 years or younger (26+/-59 days) (P<0.01). In patients over 75 years, shorter 12-month hospitalisation duration was associated with prescription of diuretics (P<0.001), ACE inhibitors (P<0.001), beta-blockers (P<0.01) and digitalis (P<0.05).
  
  
  CONCLUSIONS
  Recent advances in CHF therapy are generally applied less to patients over 75 years of age-associated with longer annual hospitalisation duration in this population. Appropriate CHF medications at hospital discharge appear to reduce annual hospitalisation duration in patients older than 75 years.
authors.affiliation: Clinical Pharmacology Department, Henri Mondor Teaching Hospital, AP-HP, Paris XII University, 94010, Créteil, France. patrick.maison@hmn.aphp.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Maison
authors.forename: Patrick
authors.initials: P
authors.lastname: Cunin
authors.forename: François
authors.initials: F
authors.lastname: Hemery
authors.forename: Florence
authors.initials: F
authors.lastname: Fric
authors.forename: Nicole
authors.initials: N
authors.lastname: Elie
authors.forename: Aldo
authors.initials: A
authors.lastname: Del'volgo
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Dubois-Randé
authors.forename: Luc
authors.initials: L
authors.lastname: Hittinger
authors.forename: Isabelle
authors.initials: I
authors.lastname: Macquin-Mavier
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D016022:Case-Control Studies; D004232:Diuretics / Q000627:therapeutic use; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D017891:Pharmacoepidemiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013148:Spironolactone / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D013148:Spironolactone