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The use of angiotensin-converting enzyme inhibitors and other drugs with cardiovascular effects by non-demented and demented elderly with a clinical diagnosis of heart failure. A population-based study of the very old

  • Pharmacoepidemiology and Prescription
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Abstract

Objectives

The aim of this study was to investigate drug treatment patterns for heart failure (HF) in the very elderly and, in particular, to determine if angiotensin-converting enzyme inhibitors (ACEIs) were under-used by demented persons.

Methods

The 265 participants investigated in this study were all 75 years and older, with HF and using cardiovascular drugs, and were part of the Nordanstig cohort (919 persons) of the population-based Kungsholmen project. Data on demographics, medical conditions, including dementia and HF from the baseline investigation 1995–1998, and drug use data from the baseline and follow-up (1999–2001) investigations were used.

Results

ACEIs were used by 25.7% of the participants. After adjustment for sociodemographic and medical background factors, there was no significant difference in ACEI use by dementia status, but use was lower with increasing age: the odds ratio (OR) was 0.11 and the 95% confidence interval (95%CI) was 0.01–0.95 between participants 90 years and older and those 75–79 years old (p=0.045). Use was also lower in those persons living in an institution compared to community-living elderly (OR: 0.28; 95% CI: 0.09–0.91; p=0.034). Only 15.8% of the participants used beta-blockers. Of the 12.8% using calcium channel blockers, 82% used preparations with negative inotropic effects. Non-steroid antiinflammatory drugs (NSAIDS), contraindicated in HF, were used by 10.6%.

Conclusions

No significant difference in ACEI utilization related to dementia diagnosis was shown, but the study did reveal a significantly lower use in the oldest age group and in elderly persons living in institutions. The low utilization rates of ACEIs and beta-blockers, the high proportion of calcium channel blockers with negative inotropic effects, and the fairly frequent use of NSAIDs in the study cohort suggest that the quality in drug treatment of very old people with HF can be improved.

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Acknowledgements

This study was supported by The National Board of Health and Welfare, Sweden; FOU-forum, The County Council of Gävleborg, Sweden; The Federation of Swedish County Councils; The National Corporation of Swedish Pharmacies’ Fund for Research and Studies in Health Economics and Social Pharmaceutics.

Conflict of interest statement

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Aging Research Center, Division of Geriatric Epidemiology, Neurotec, Karolinska Institutet, Gävlegatan 16, 113 30, Stockholm, Sweden

    Inga Klarin, Johan Fastbom & Anders Wimo

  2. Stockholm Gerontology Research Center, Stockholm, Sweden

    Inga Klarin, Johan Fastbom & Anders Wimo

  3. Clinic of Geriatric Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden

    Inga Klarin

  4. HC Bergsjö, Bergsjö, Sweden

    Anders Wimo

Authors
  1. Inga Klarin
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  2. Johan Fastbom
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  3. Anders Wimo
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Corresponding author

Correspondence to Inga Klarin.

Appendix

Appendix

DSM-III-R criteria for dementia (abbreviated) [29]

  1. 1.

    Demonstrable evidence of impairment in short- and long-term memory.

  2. 2.

    At least one of the following:

    1. a)

      Impairment in abstract thinking.

    2. b)

      Impaired judgment.

    3. c)

      Other disturbances of higher cortical function, as aphasia, apraxia, agnosia, and “constructional difficulty”.

    4. d)

      Personality change; for example, alteration or accentuation of premorbid traits.

  3. 3.

    The disturbance in points 1 and 2 significantly interferes with work or usual social activities or relationships with others.

  4. 4.

    Not occurring exclusively during the course of delirium

  5. 5.

    Either (a) or (b) of the following:

    1. a)

      There is evidence from the history, physical examination, or laboratory tests of a specific organic factor (or factors) judged to be etiologically related to the disturbance

    2. b)

      In the absence of such evidence, an etiologic organic factor can be presumed if the disturbance cannot be accounted for by any nonorganic mental disorder; for example, a major depression accounting for cognitive impairment.

Table 5 Pharmacological treatment options in the Swedish guidelines for treatment of chronic heart failure at the time of the baseline data collection (abbreviated)
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Klarin, I., Fastbom, J. & Wimo, A. The use of angiotensin-converting enzyme inhibitors and other drugs with cardiovascular effects by non-demented and demented elderly with a clinical diagnosis of heart failure. A population-based study of the very old. Eur J Clin Pharmacol 62, 555–562 (2006). https://doi.org/10.1007/s00228-006-0134-y

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  • DOI: https://doi.org/10.1007/s00228-006-0134-y

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