Department of Integrative Medical Biology, Umeå University, Umeå, 901 87, Sweden.
Department of Nursing, Umeå University, Umeå, 901 87, Sweden.
BMC Geriatr. 2023 Aug 29;23(1):524. doi: 10.1186/s12877-023-04223-3.
To achieve the best treatment of heart failure, it is important to use all recommended drugs at their target doses. Given that underuse of medications can occur in individuals with cognitive impairment, we investigated the filled prescriptions and target doses of heart failure medication for older individuals with and without cognitive impairment as well as associated factors.
The study was based on two separate datasets. The first dataset, which was based on data from questionnaires sent to nursing homes in Sweden, included 405 individuals with heart failure. The data were linked with the Swedish Prescribed Drug Register and the National Patient Register to obtain information regarding filled prescriptions of heart failure medications and heart failure diagnoses among the population. In the second dataset, medical records of individuals aged 75 years or older admitted to a hospital in northern Sweden were reviewed and individuals with heart failure were identified. Target doses of heart failure medications were evaluated in 66 individuals who lived at home.
Filled prescriptions of mineralocorticoid receptor antagonists and loop diuretics were significantly more common in individuals without cognitive impairment (OR 1.087; 95% CI 1.026-1.152, p < 0.05) and (OR 1.057; 95% CI 1.017-1.098, p < 0.05), respectively. There were no significant differences between individuals with and without cognitive impairment in terms of achieving target doses for any of the drug classes. A higher age was associated with fewer filled prescriptions and less ability to reach the target doses of beta blockers (OR 0.950; 95% CI 0.918-0.984, p < 0.05) and (OR 0.781; 95% CI 0.645-0.946, p < 0.05), respectively.
Our results suggest that individuals with cognitive impairment are partly undertreated for heart failure in that they had fewer filled prescriptions of important heart medications. Separately, the relatively low proportion of older individuals reaching target doses is an important observation and indicates that treatment of heart failure could be further optimised among older individuals.
为了实现心力衰竭的最佳治疗效果，重要的是要以目标剂量使用所有推荐的药物。鉴于认知障碍患者可能会出现药物使用不足的情况，我们调查了有认知障碍和无认知障碍的老年心力衰竭患者的心力衰竭药物的处方和目标剂量以及相关因素。
本研究基于两个独立的数据集。第一个数据集基于瑞典疗养院寄来的问卷数据，包括 405 名心力衰竭患者。这些数据与瑞典处方药物登记处和国家患者登记处相关联，以获取人群中心力衰竭药物的处方和心力衰竭诊断信息。在第二个数据集，审查了瑞典北部一家医院收治的 75 岁或以上老年人的病历，并确定了心力衰竭患者。评估了 66 名居住在家中的心力衰竭患者的心力衰竭药物目标剂量。
无认知障碍患者的利尿剂和盐皮质激素受体拮抗剂的处方明显更为常见（比值比 1.087；95%置信区间 1.026-1.152，p<0.05）和（比值比 1.057；95%置信区间 1.017-1.098，p<0.05）。在达到任何药物类别目标剂量方面，认知障碍患者与无认知障碍患者之间无显著差异。较高的年龄与较少的处方和较少的β受体阻滞剂达到目标剂量有关（比值比 0.950；95%置信区间 0.918-0.984，p<0.05）和（比值比 0.781；95%置信区间 0.645-0.946，p<0.05）。
我们的结果表明，认知障碍患者在心力衰竭治疗方面存在部分不足，他们的重要心力衰竭药物处方较少。单独来看，年龄较大的患者达到目标剂量的比例相对较低，这是一个重要的观察结果，表明需要进一步优化老年心力衰竭患者的治疗。
