title: Treatment of heart failure in nursing home residents.
abstract: BACKGROUND
  For the treatment of chronic heart failure (HF), both pharmacological and non-pharmacological treatment should be employed in HF patients. Although HF is highly prevalent in nursing home residents, it is not clear whether the recommendations in the guidelines for pharmacological therapy also are followed in nursing home residents. The aim of this study is to investigate how HF is treated in nursing home residents and to determine to what extent the current treatment corresponds to the guidelines.
  
  
  METHODS
  Nursing home residents of five large nursing home care organizations in the southern part of the Netherlands with a previous diagnosis of HF based on medical records irrespective of the left ventricle ejection fraction (LVEF) were included in this cross-sectional design study. Data were gathered on the (medical) records, which included clinical characteristics and pharmacological- and non-pharmacological treatment. Echocardiography was used as part of the study to determine the LVEF.
  
  
  RESULTS
  Out of 501 residents, 112 had a diagnosis of HF at inclusion. One-third of them received an ACE-inhibitor and 40% used a β-blocker. In 66%, there was a prescription of diuretics with a preference of a loop diuretic. Focusing on the residents with a LVEF ≤ 40%, only 46% of the 22 residents used an ACE-inhibitor and 64% a β-blocker. The median daily doses of prescribed medication were lower than those that were recommended by the guidelines. Non-pharmacological interventions were recorded in almost none of the residents with HF.
  
  
  CONCLUSIONS
  The recommended medical therapy of HF was often not prescribed; if prescribed, the dosage was usually far below what was recommended. In addition, non-pharmacological interventions were mostly not used at all.
authors.affiliation: Department of Health Services Research, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands.
authors.forename: Mariëlle Amj
authors.initials: MA
authors.lastname: Daamen
authors.affiliation: Department of Health Services Research, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands.
authors.forename: Jan Ph
authors.initials: JP
authors.lastname: Hamers
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Anton Pm
authors.initials: AP
authors.lastname: Gorgels
authors.affiliation: Department of Methodology and Statistics, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands.
authors.forename: Frans Es
authors.initials: FE
authors.lastname: Tan
authors.affiliation: Department of Health Services Research, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Department of Family Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands.
authors.forename: Jos Mga
authors.initials: JM
authors.lastname: Schols
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-la Rocca
keywords: Ejection fraction; Heart failure; Nursing home; Treatment