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Utilisation of medications recommended for chronic heart failure and the relationship with annual hospitalisation duration in patients over 75 years of age. A pharmacoepidemiological study

  • Pharmacoepidemiology and Prescription
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Abstract

Objectives

Trials in chronic heart failure (CHF) include few patients older than 75 years, who represent a large proportion of CHF patients. We evaluated the influence of age on CHF-medication use and of CHF medications on hospitalisation in patients older than 75 years.

Methods

Included in our nested case-control study were 281 patients admitted in 2000 to a French teaching hospital with a main diagnosis of CHF and monitored over a 12-month period. Patient characteristics, medications at discharge, outpatient medications and hospitalisation frequency and duration were compared by means of univariate and multivariate analyses.

Results

Patients older than 75 years (n=150) and 75 years or younger (n=131) were similar with regard to NYHA class and ejection fraction. At discharge, diuretic use was similar in the two groups, but fewer older patients were prescribed angiotensin-converting enzyme (ACE) inhibitors (48% versus 63%, P<0.01) or beta-blockers (19% versus 37%, P<0.001). During follow-up, total re-admission rate and mean number of re-admissions were similar; however, total hospitalisation duration was greater in patients older than 75 years (38±77 days) than in those 75 years or younger (26±59 days) (P<0.01). In patients over 75 years, shorter 12-month hospitalisation duration was associated with prescription of diuretics (P<0.001), ACE inhibitors (P<0.001), beta-blockers (P<0.01) and digitalis (P<0.05).

Conclusions

Recent advances in CHF therapy are generally applied less to patients over 75 years of age—associated with longer annual hospitalisation duration in this population. Appropriate CHF medications at hospital discharge appear to reduce annual hospitalisation duration in patients older than 75 years.

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References

  1. Butler J, Arbogast PG, Daugherty J, Jain MK, Ray WA, Griffin MR (2004) Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge. J Am Coll Cardiol 43:2036–2043

    Article  CAS  PubMed  Google Scholar 

  2. Cleland JG, Swedberg K, Cohen-Solal A, Cosin-Aguilar J, Dietz R, Follath F et al (2000) The euro heart failure survey of the EUROHEART survey programme. A survey on the quality of care among patients with heart failure in Europe. The study group on diagnosis of the working group on heart failure of the European society of cardiology. The Medicines Evaluation Group Centre for Health Economics University of York. Eur J Heart Fail 2:123–132

    Article  CAS  PubMed  Google Scholar 

  3. Cohen-Solal A, Desnos M, Delahaye F, Emeriau JP, Hanania G (2000) A national survey of heart failure in French hospitals. The Myocardiopathy and heart failure working group of the French society of cardiology, the national college of general hospital cardiologists and the French geriatrics society. Eur Heart J 21:763–769

    Google Scholar 

  4. Cowie MR (1999) Annotated references in epidemiology. Eur J Heart Fail 1:101–107

    Article  CAS  PubMed  Google Scholar 

  5. Cowie MR, Fox KF, Wood DA, Metcalfe C, Thompson SG, Coats AJ et al (2002) Hospitalization of patients with heart failure: a population-based study. Eur Heart J 23:877–885

    Google Scholar 

  6. Davis RC, Hobbs FD, Kenkre JE, Roalfe AK, Hare R, Lancashire RJ et al (2002) Prevalence of left ventricular systolic dysfunction and heart failure in high risk patients: community based epidemiological study. BMJ 325:1156

    Article  CAS  PubMed  Google Scholar 

  7. Gottdiener JS, Arnold AM, Aurigemma GP, Polak JF, Tracy RP, Kitzman DW et al (2000) Predictors of congestive heart failure in the elderly: the cardiovascular health study. J Am Coll Cardiol 35:1628–1637

    Article  CAS  PubMed  Google Scholar 

  8. Havranek EP, Masoudi FA, Westfall KA, Wolfe P, Ordin DL, Krumholz HM (2002) Spectrum of heart failure in older patients: results from the national heart failure project. Am Heart J 143:412–417

    Article  PubMed  Google Scholar 

  9. Higashi T, Shekelle PG, Solomon DH, Knight EL, Roth C, Chang JT et al (2004) The quality of pharmacologic care for vulnerable older patients. Ann Intern Med 140:714–720

    PubMed  Google Scholar 

  10. Horwich TB, MacLellan WR, Fonarow GC (2004) Statin therapy is associated with improved survival in ischemic and non-ischemic heart failure. J Am Coll Cardiol 43:642–648

    Article  CAS  PubMed  Google Scholar 

  11. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS et al (2001) ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American college of cardiology/American heart association task force on practice guidelines (committee to revise the 1995 guidelines for the evaluation and management of heart failure). J Am Coll Cardiol 38:2101–2113

    Article  CAS  PubMed  Google Scholar 

  12. Johnson D, Jin Y, Quan H, Cujec B (2003) Beta-blockers and angiotensin-converting enzyme inhibitors/receptor blockers prescriptions after hospital discharge for heart failure are associated with decreased mortality in Alberta, Canada. J Am Coll Cardiol 42:1438–1445

    Article  PubMed  Google Scholar 

  13. Ko DT, Mamdani M, Alter DA (2004) Lipid-lowering therapy with statins in high-risk elderly patients: the treatment-risk paradox. JAMA 291:1864–1870

    Article  CAS  PubMed  Google Scholar 

  14. Komajda M, Bouhour JB, Amouyel P, Delahaye F, Vicaut E, Croce I et al (2001) Ambulatory heart failure management in private practice in France. Eur J Heart Fail 3:503–507

    Google Scholar 

  15. Komajda M, Follath F, Swedberg K, Cleland J, Aguilar JC, Cohen-Solal A et al (2003) The euro heart failure survey programme–a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J 24:464–474

    Article  CAS  PubMed  Google Scholar 

  16. Litaker JR, Chou JY (2003) Patterns of pharmacologic treatment of congestive heart failure in elderly nursing home residents and related issues: a review of the literature. Clin Ther 25:1918–1935

    Article  CAS  PubMed  Google Scholar 

  17. Node K, Fujita M, Kitakaze M, Hori M, Liao JK (2003) Short-term statin therapy improves cardiac function and symptoms in patients with idiopathic dilated cardiomyopathy. Circulation 108:839–843

    CAS  PubMed  Google Scholar 

  18. Philbin EF, DiSalvo TG (1999) Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data. J Am Coll Cardiol 33:1560–1566

    Article  CAS  PubMed  Google Scholar 

  19. Philbin EF, Rocco TA Jr, Lindenmuth NW, Ulrich K, Jenkins PL (1999) Clinical outcomes in heart failure: report from a community hospital-based registry. Am J Med 107:549–555

    Article  CAS  PubMed  Google Scholar 

  20. Philbin EF, Rocco TA Jr, Lindenmuth NW, Ulrich K, Jenkins PL (2000) Systolic versus diastolic heart failure in community practice: clinical features, outcomes, and the use of angiotensin-converting enzyme inhibitors. Am J Med 109:605–613

    Article  CAS  PubMed  Google Scholar 

  21. Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM (1995) A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 333:1190–1195

    Article  CAS  PubMed  Google Scholar 

  22. Senni M, Tribouilloy CM, Rodeheffer RJ, Jacobsen SJ, Evans JM, Bailey KR et al (1999) Congestive heart failure in the community: trends in incidence and survival in a 10-year period. Arch Intern Med 159:29–34

    Article  CAS  PubMed  Google Scholar 

  23. Stewart S, Marley JE, Horowitz JD (1999) Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study. Lancet 354:1077–1083

    Article  CAS  PubMed  Google Scholar 

  24. Wattigney WA, Mensah GA, Croft JB (2003) Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: implications for primary prevention. Circulation 108:711–716

    Article  PubMed  Google Scholar 

  25. Zannad F, Briancon S, Juilliere Y, Mertes PM, Villemot JP, Alla F et al (1999) Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL study. Epidemiologie de l’insuffisance cardiaque avancee en lorraine. J Am Coll Cardiol 33:734–742

    Article  CAS  PubMed  Google Scholar 

  26. Struthers AD, Anderson G, Donnan PT, MacDonald T (2000) Social deprivation increases cardiac hospitalisations in chronic heart failure independent of disease severity and diuretic non-adherence. Heart 83:12–16

    Article  CAS  PubMed  Google Scholar 

  27. Philbin EF, Dec GW, Jenkins PL, DiSalvo TG (2001) Socioeconomic status as an independent risk factor for hospital readmission for heart failure. Am J Cardiol 87:1367–1371

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This study was performed in accordance with the current laws and regulations governing such studies in France.

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Authors and Affiliations

  1. Clinical Pharmacology Department, Henri Mondor Teaching Hospital, AP-HP, Paris XII University, 94010, Créteil, France

    Patrick Maison, Florence Fric & Isabelle Macquin-Mavier

  2. Clinical Research Unit, Henri Mondor Hospital, AP-HP, Paris XII University, 94010, Créteil, France

    Patrick Maison & Patrick Cunin

  3. Research Unit INSERM U258, Villejuif, France

    Patrick Maison

  4. Medical Informatics Department, Henri Mondor Hospital, AP-HP, Paris XII University, 94010, Créteil, France

    François Hemery

  5. Medical adviser, National Health Insurance Fund, 94010, Créteil, France

    Nicole Elie & Aldo Del’Volgo

  6. Cardiology Federation, Henri Mondor Hospital, AP-HP, Paris XII University, 94010, Créteil, France

    Jean Luc Dubois-Randé & Luc Hittinger

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  1. Patrick Maison
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  2. Patrick Cunin
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  9. Isabelle Macquin-Mavier
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Correspondence to Patrick Maison.

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Maison, P., Cunin, P., Hemery, F. et al. Utilisation of medications recommended for chronic heart failure and the relationship with annual hospitalisation duration in patients over 75 years of age. A pharmacoepidemiological study. Eur J Clin Pharmacol 61, 445–451 (2005). https://doi.org/10.1007/s00228-005-0939-0

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  • DOI: https://doi.org/10.1007/s00228-005-0939-0

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