title: Implementation of beta-blockade in elderly heart failure patients: role of the nurse specialist.
abstract: BACKGROUND
  Beta-blockers (BB) are under prescribed in elderly heart failure (HF) patients. We analysed predictors of BB treatment in relation to age in community patients seen at an HF clinic with nurse specialist support.
  
  
  METHODS
  BB prescription was assessed in 357 subjects, in relation to age tertiles:<67 (n=120), 67-73 (n=105) and >or=74 years (n=119).
  
  
  RESULTS
  305 patients (85%) took BB at a median carvedilol-equivalent daily dose of 12.5 [12.5-25] mg. Patients >or=74 years received significantly less BB (78% vs 93% and 85%, p=0.002) and at lower doses than subjects aged <67 and 67-73 years (12.5 [6.25-20] mg vs 25 [12.5-32] and 12.5 [12.5-25], p=0.002). Older age, chronic obstructive airways disease, amiodarone, digoxin and baseline heart rate were independently associated with non-prescription of BB.
  
  
  CONCLUSIONS
  Although older age is associated with non-prescription of BB, BB can be implemented in an outpatient HF clinic with nurse specialist support even in elderly patients. although lower doses are achieved than in younger subjects.
authors.affiliation: Cardiology Unit Azienda Istituti Ospedalieri, Cremona, Milan, Italy.
authors.forename: Miriam
authors.initials: M
authors.lastname: Mariani
authors.forename: Giovanna
authors.initials: G
authors.lastname: Vella
authors.forename: Carlo
authors.initials: C
authors.lastname: Bianchi
authors.forename: Simone
authors.initials: S
authors.lastname: Verde
authors.forename: Renata
authors.initials: R
authors.lastname: De Maria
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pirelli
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D016903:Drug Monitoring; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy* / Q000451:nursing*; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians; D024802:Nurse's Role; D010044:Outpatient Clinics, Hospital; D010347:Patient Care Planning; D010349:Patient Compliance; D010353:Patient Education as Topic
chemical_list: D000319:Adrenergic beta-Antagonists