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Quality of care in congestive heart failure in the elderly: epidemiological evidence of a gap between guidelines and clinical practice

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Abstract

Background and aims: This study aimed at evaluating the quality of care in elderly patients hospitalized for heart failure, compared with that received by subjects of younger age. Methods: A cross-sectional retrospective study was performed on hospitalized subjects for heart failure in the Veneto Region (4.5 million inhabitants), located in North-East Italy, for the year 2004. Through consultation of clinical charts, performance of echocardiography, and prescription of ACE-inhibitors and β-blockers were evaluated in each patient. Multivariate statistical analysis was used to test the association between age and the end-points of interest: prescription of ACE-inhibitors or β-blockers and performance of echocardiography. Results: The percentage of patients with prescriptions for ACE-inhibitors decreased with age, from 75% for patients under 65 years, to 62% for subjects over 84 years (p=0.02). A similar, but more marked, finding was observed for prescriptions of β-blockers (56% in subjects aged <65 yrs vs 16% in those aged >84 yrs) (p<0.001). Evaluation of echocardiography was performed in 61 % of subjects under 65 and in 22% in those over 84 (p<0.001). After statistical adjustment, age remained a significant predictor of prescription for β-blockers and performance of echocardiography, but no longer for prescription of ACE-inhibitors. Conclusions: Among the elderly, age was a negative predictor of β-blocker prescription and echocardiographic evaluation, but did not affect prescriptions for ACE-inhibitors.

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Authors and Affiliations

  1. Epidemiological Department, Veneto Region, Castelfranco Veneto, Italy

    Stefano Brocco, Maria Marchesan, Elena Schievano, Francesco Zambon & Paolo Spolaore

  2. Division of Geriatric Medicine, University of Verona, Italy

    Mauro Zamboni, Francesco Fantin, Chiara Bozzano & Vincenzo Di Francesco

  3. Division of Cardiology, University of Verona, Italy

    Corrado Vassanelli

Authors
  1. Stefano Brocco
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  2. Mauro Zamboni
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  3. Francesco Fantin
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  4. Maria Marchesan
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  5. Elena Schievano
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  6. Francesco Zambon
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  7. Chiara Bozzano
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  8. Vincenzo Di Francesco
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  9. Corrado Vassanelli
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  10. Paolo Spolaore
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Correspondence to Stefano Brocco.

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Brocco, S., Zamboni, M., Fantin, F. et al. Quality of care in congestive heart failure in the elderly: epidemiological evidence of a gap between guidelines and clinical practice. Aging Clin Exp Res 22, 243–248 (2010). https://doi.org/10.1007/BF03324803

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  • DOI: https://doi.org/10.1007/BF03324803

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