A review of the management of heart failure in long-term care residents.
OBJECTIVE
The objective of this study was to describe the characteristics of long-term care residents with heart failure (HF), to evaluate the management of HF, and to compare their management with nationally published American College of Cardiology/American Heart Association guidelines.


METHODS
Residents in long-term care facilities were identified by diagnosis of HF within their electronic medical record.


METHODS
Data were collected on 302 residents in 19 long-term care facilities. The average age of the study population was 83.2 +/- 11.1 years and comprised 68.5% females.


RESULTS
Diabetes, obesity, hypertension, coronary artery disease, dementia, and hypothyroidism were identified in greater than 30% of residents. A diuretic was prescribed in 76.8% of residents. Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers were prescribed to 40.7% and 38.4% of residents, respectively; 16.2% of residents received both agents. Residents with diabetes or hypertension were not prescribed ACE inhibitors more often than residents without these comorbidities. Digoxin was prescribed more frequently in residents with atrial fibrillation (P = 0.028). Hospital admissions related to HF were documented in 30 (9.9%) residents within the past 12 months.


CONCLUSIONS
According to guidelines, most patients with HF should be routinely managed with a combination of four types of drugs: a diuretic, an ACE inhibitor, a betablocker, and, often, digoxin. Improvement in HF outcomes resulting in reduced morbidity and mortality may be achieved through greater adherence to nationally recognized guidelines. Opportunities exist for health care professionals to improve the management of residents with HF through appropriate drug therapy management.
Mann
Jodi L
JL
Butler University College of Pharmacy, Indianapolis, Indiana, USA.
Evans
Tamara S
TS
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D002317:Cardiovascular Agents; D004232:Diuretics; D004077:Digoxin