Quality of care in congestive heart failure in the elderly: epidemiological evidence of a gap between guidelines and clinical practice.
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.
Brocco
Stefano
S
Epidemiological Department, Veneto Region, Castelfranco Veneto, Italy. stefano.brocco@ulssasolo.ven.it
Zamboni
Mauro
M
Fantin
Francesco
F
Marchesan
Maria
M
Schievano
Elena
E
Zambon
Francesco
F
Bozzano
Chiara
C
Di Francesco
Vincenzo
V
Vassanelli
Corrado
C
Spolaore
Paolo
P
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
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors