title: Age-related gap in the management of heart failure patients. The National Project of Prevention and Treatment of Cardiovascular Diseases--POLKARD.
abstract: BACKGROUND
  Heart failure (HF) is strongly associated with aging. It affects 10-12% of patients older than 80 years, with five-year overall mortality after first hospitalization for HF being as high as 81%. The main objective of this study was to assess the diagnosis and treatment of HF in hospitalized octogenarians compared to younger subjects.
  
  
  METHODS
  The survey was performed among a random sample of all Polish hospitals and in all academic centers, as part of the National Project of Prevention and Treatment of Cardiovascular Diseases in Poland -- POLKARD. Using a questionnaire-based method, hospital documentation of the last five patients with diagnosed HF was reviewed. Eventually, in 2005, HF patients of 259 internal medicine and cardiology hospital wards, including 260 very elderly patients, were selected to the study.
  
  
  RESULTS
  The mean age of the 1,289 studied patients was 69.8 ± 11.4 years (age range: 26-96 years), 57.8% were males, and 80.1% were in NYHA class III or IV. Echocardiography was performed in 41.7% of octogenarians in comparison with 58.7% of those categorized as younger elderly, i.e. 60-79 years, and 75.2% of patients aged below 60 years (p < 0.0001). The most prescribed drugs in very elderly patients were diuretics (86.9%, p = 0.005) and ACE-I (81.9%), while only 61.5% used beta-blockers (p < 0.0001). In stepwise logistic regression analysis, hypertension, history of myocardial infarction and admission to cardiology ward were positively associated with beta-blocker and ACE-I (or ARB) therapy, while older age and pulmonary diseases (COPD or asthma) were related to their non-prescription.
  
  
  CONCLUSIONS
  Despite significant progress in HF management, there is still a need for an improvement in the medical care of very elderly patients. The major obstacles seem to be advanced age and the presence of coexistent pulmonary diseases. Therefore, the participation of geriatricians and pulmonologists should be recommended in caring for octogenarians with HF.
authors.affiliation: Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Matusik
authors.forename: Marzena
authors.initials: M
authors.lastname: Dubiel
authors.forename: Barbara
authors.initials: B
authors.lastname: Wizner
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Fedyk-Łukasik
authors.forename: Tomasz
authors.initials: T
authors.lastname: Zdrojewski
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
authors.forename: Jacek
authors.initials: J
authors.lastname: Dubiel
authors.forename: Tomasz
authors.initials: T
authors.lastname: Grodzicki
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D002304:Cardiac Pacing, Artificial; D016507:Cardiology Service, Hospital; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006334:Heart Function Tests; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011044:Poland / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D012307:Risk Factors; D015607:Stents; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents