Trends in prescribing ACE-inhibitors for congestive heart failure in elderly people

Background and aims:The aim of this study was to analyze trends in the use of ACE-inhibitors in patients aged 65 and older with congestive heart failure (CHF) in the period from 1988 to 1998. Methods:We studied 2985 patients (mean age 79.7±7 years), hospitalized for CHF in 12 different bimonthly periods. Home therapy prior to hospitalization was assessed retrospectively, and data on in-hospital therapy and discharge prescriptions were collected prospectively. Results:Diuretics and digitalis were the most commonly used and prescribed drugs. The use of ACE-inhibitors between 1988 and 1998 increased from 13.4 to 46.7% prior to hospitalization, and from 25.8 to 59.2% as a discharge prescription. The most important factors associated with a prescription of ACE-inhibitors at discharge were previous use (OR 4.35, 95% CI=3.65–5.19), hypertension (OR 1.76, 95% CI=1.47–2.11), valvular heart diseases (OR 2.06, 95% CI=1.51–2.81) and diabetes (OR 1.58, 95% CI=1.29–1.93). Physical impairment was associated with a decreased use of ACE-inhibitors at discharge (OR 0.55, 95% CI=0.45–0.67). Conclusions:The use of ACE-inhibitors for the treatment of CHF progressively increased both at home and in hospital wards of general medicine and geriatrics in the 10-year period studied. Nevertheless, digitalis and diuretics continue to be the most commonly prescribed drugs. A widespread educational effort is needed to increase physicians’ awareness of the rationale for prescribing ACE-inhibitors for CHF patients.