PMID- 9848817
OWN - NLM
STAT- MEDLINE
DCOM- 19981218
LR  - 20210929
IS  - 0002-8614 (Print)
IS  - 0002-8614 (Linking)
VI  - 46
IP  - 12
DP  - 1998 Dec
TI  - Evaluating the use of angiotensin-converting enzyme inhibitors for older nursing 
      home residents with chronic heart failure.
PG  - 1550-4
AB  - BACKGROUND: Despite their well noted therapeutic benefits for heart failure (HF), 
      angiotensin-converting enzyme (ACE) inhibitors may be underprescribed and 
      underdosed among older nursing home patients. OBJECTIVES: To assess the use of 
      ACE inhibitor therapy in older (> or =70 years) nursing home residents with 
      systolic heart failure (HF). DESIGN: A cross-sectional, retrospective analysis. 
      SETTING: Five long-term care facilities in Providence, Rhode Island. SUBJECTS: 
      Adults aged 70 years or older with left ventricular (LV) ejection fractions < or 
      =40%. MEASUREMENTS: New York Heart Association (NYHA) class, comorbid diseases, 
      and cardiac medications with logistic regression analysis to clarify their 
      bearing on the prescription of ACE inhibitors. RESULTS: Of the 819 nursing home 
      residents who were evaluated, 119 (24 men, 95 women) fulfilled exacting entry 
      criteria, i.e., heart failure signs/symptoms and documented LV systolic 
      dysfunction. Forty-one of these 119 (35%) older persons were receiving ACE 
      inhibitor therapy, predominantly in doses (< or =50 mg captopril/day or < or =5 
      mg enalapril/ day) less than those of proven therapeutic efficacy. Compared with 
      older residents not receiving ACE inhibitors, those receiving ACE inhibitors 
      included fewer with NYHA Class I HF (0 vs 21%, P = .017), more men (58 vs 28%, P< 
      or =.01), and more people with hypertension (61 vs 35%, P< or =.01). In contrast, 
      diuretics were prescribed more frequently among those not receiving ACE 
      inhibitors (83 vs 56%, P< or =.001). CONCLUSIONS: ACE inhibitors are 
      underprescribed and underdosed among elderly nursing home patients carefully 
      screened to include systolic HF and no contraindications to the medication. ACE 
      inhibitors are particularly underused in those elderly with NYHA Class I HF and 
      in those receiving diuretics.
FAU - Forman, D E
AU  - Forman DE
AD  - The Miriam and Rhode Island Hospitals, Brown University, Providence 02906, USA.
FAU - Chander, R B
AU  - Chander RB
FAU - Lapane, K L
AU  - Lapane KL
FAU - Shah, P
AU  - Shah P
FAU - Stoukides, J
AU  - Stoukides J
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Am Geriatr Soc
JT  - Journal of the American Geriatrics Society
JID - 7503062
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
SB  - IM
CIN - J Am Geriatr Soc. 1999 Nov;47(11):1385-6. PMID: 10573456
MH  - Aged
MH  - Aged, 80 and over
MH  - Angiotensin-Converting Enzyme Inhibitors/*administration & dosage/adverse effects
MH  - Chronic Disease
MH  - Cross-Sectional Studies
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Female
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Male
MH  - Nursing Homes
MH  - Retrospective Studies
MH  - Rhode Island
MH  - Treatment Outcome
MH  - Ventricular Function, Left/drug effects
EDAT- 1998/12/16 16:56
MHDA- 2000/03/18 09:00
CRDT- 1998/12/16 16:56
PHST- 1998/12/16 16:56 [pubmed]
PHST- 2000/03/18 09:00 [medline]
PHST- 1998/12/16 16:56 [entrez]
AID - 10.1111/j.1532-5415.1998.tb01541.x [doi]
PST - ppublish
SO  - J Am Geriatr Soc. 1998 Dec;46(12):1550-4. doi: 
      10.1111/j.1532-5415.1998.tb01541.x.