© 2005 European Society of Cardiology
Utilization of evidence-based therapies for heart failure in the institutionalized elderly
EPICORE Centre, Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta 220 College Plaza Edmonton, Alberta, Canada T6G 2C8
* Corresponding author. Tel.: +1 780 492 8526; fax: +1 780 492 6059. E-mail address: ross.tsuyuki{at}ualberta.ca
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Abstract |
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Objectives: Heart failure (HF) is a major source of morbidity and mortality in elderly populations. A significant proportion of the elderly with HF are living in long-term care facilities. Little is known about their management. The aim of this study was to evaluate the use of evidence-based therapies in institutionalized elderly patients with HF.
Design, setting and participants: Retrospective chart review conducted at 15 long-term care facilities in the Capital Health Region (Edmonton, Alberta). Residents 
65 years of age with HF were identified using a pharmacy database.
Results: Overall prevalence of HF was 15% (313/2062 residents). Mean age was 87 years, median duration of residence was 1.8 years. Utilization of ACE-inhibitors, beta-blockers and spironolactone was 51%, 16% and 10%, respectively. Use of these medications was not significantly different between subgroups of those with and without contraindications to the therapies, different advance directive levels, gender or age. Sodium and fluid restricted diets were prescribed in only 11.0% and 3.8% of residents. Weight was not regularly monitored. Influenza and pneumococcal vaccination were administered to 60.4% and 81.2% of the residents.
Conclusion: The use of evidence-based therapies in institutionalized elderly patients with HF is low, and unexplained by contraindications or advance directives. Efforts to increase the utilization of evidence-based therapies and improve monitoring are warranted.
Key Words: Elderly • Heart failure • Treatment • Nursing home
Received July 2, 2004; Accepted March 3, 2005