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

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.