title: Impact of comorbidity on medication use in elderly patients with cardiovascular diseases: the OCTOCARDIO study.
abstract: BACKGROUND
  Recommended medications are under-prescribed in elderly patients with atrial fibrillation (AF), coronary artery disease (CAD), and congestive heart failure (CHF). The relationship between under-prescribing and comorbidity is unclear.
  
  
  METHODS
  Single-day observational study.
  
  
  METHODS
  Analysis of medications taken by patients aged 80 years or over at the time of their admission to cardiology units of 32 French hospitals. Comorbidity was measured using the Charlson comorbidity index (CCI).
  
  
  RESULTS
  The study included 510 patients (57% men, mean age 85 years). History of AF, CHF, and CAD was present in 213 (42%), 199 (39%), and 187 (37%) patients, respectively. CCI was 0 in 110 (22%), 1-2 in 215 (42%), and ≥3 in 185 (36%) patients. Vitamin K antagonists (VKA) were prescribed to 105 (49%) and aspirin to 86 (40%) patients with AF. CCI did not influence VKA prescription but influenced aspirin use, with lower prescription rates in patients with CCI 1-2 than CCI 0 or CCI ≥3 (p = 0.02). In CHF, angiotensin-converting enzyme inhibitors (ACEI) and β-blockers were prescribed to 80 (40%) and 96 (48%) patients, respectively. Rates of prescription of ACEI, β-blockers, statins, and aspirin in patients with CAD were 43%, 56%, 56%, and 66%, respectively. CCI level did not influence any medication use in CHF and CAD.
  
  
  CONCLUSIONS
  Even in the absence of comorbidity, elderly patients with major cardiovascular diseases are denied from indicated medical treatments probably because of their age alone. Implementing measures to enhance awareness of treatment benefits and promote appropriate prescribing is necessary.
authors.affiliation: Groupe Hospitalier Paris Saint-Joseph, Paris, France. ghassan.moubarak@gmail.com
authors.forename: Ghassan
authors.initials: G
authors.lastname: Moubarak
authors.forename: Laura
authors.initials: L
authors.lastname: Ernande
authors.forename: Matthieu
authors.initials: M
authors.lastname: Godin
authors.forename: Serge
authors.initials: S
authors.lastname: Cazeau
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Olivier
authors.initials: O
authors.lastname: Hanon
authors.forename: Stephane
authors.initials: S
authors.lastname: Zuily
authors.forename: Francois
authors.initials: F
authors.lastname: Tournoux
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.forename: Genevieve
authors.initials: G
authors.lastname: Derumeaux
authors.forename: Alexis
authors.initials: A
authors.lastname: Mechulan
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology; D001291:Attitude of Health Personnel; D001364:Awareness; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology; D016009:Chi-Square Distribution; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents