title: Quality of care in congestive heart failure in the elderly: epidemiological evidence of a gap between guidelines and clinical practice.
abstract: OBJECTIVE
  This study aimed at evaluating the quality of care in elderly patients hospitalized for heart failure, compared with that received by subjects of younger age.
  
  
  METHODS
  A cross-sectional retrospective study was performed on hospitalized subjects for heart failure in the Veneto Region (4.5 million inhabitants), located in North-East Italy, for the year 2004. Through consultation of clinical charts, performance of echocardiography, and prescription of ACE-inhibitors and beta-blockers were evaluated in each patient. Multivariate statistical analysis was used to test the association between age and the end-points of interest: prescription of ACE-inhibitors or beta- blockers and performance of echocardiography.
  
  
  RESULTS
  The percentage of patients with prescriptions for ACE-inhibitors decreased with age, from 75% for patients under 65 years, to 62% for subjects over 84 years (p=0.02). A similar, but more marked, finding was observed for prescriptions of beta- blockers (56% in subjects aged <65 yrs vs 16% in those aged >84 yrs) (p<0.001). Evaluation of echocardiography was performed in 61% of subjects under 65 and in 22% in those over 84 (p<0.001). After statistical adjustment, age remained a significant predictor of prescription for beta-blockers and performance of echocardiography, but no longer for prescription of ACE-inhibitors.
  
  
  CONCLUSIONS
  Among the elderly, age was a negative predictor of beta-blocker prescription and echocardiographic evaluation, but did not affect prescriptions for ACE-inhibitors.
authors.affiliation: Epidemiological Department, Veneto Region, Castelfranco Veneto, Italy. stefano.brocco@ulssasolo.ven.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Brocco
authors.forename: Mauro
authors.initials: M
authors.lastname: Zamboni
authors.forename: Francesco
authors.initials: F
authors.lastname: Fantin
authors.forename: Maria
authors.initials: M
authors.lastname: Marchesan
authors.forename: Elena
authors.initials: E
authors.lastname: Schievano
authors.forename: Francesco
authors.initials: F
authors.lastname: Zambon
authors.forename: Chiara
authors.initials: C
authors.lastname: Bozzano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Francesco
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Spolaore
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors