Department of Medical and Translational Biology, Umeå University, Umeå, 901 87, Sweden.
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, 901 87, Sweden.
BMC Geriatr. 2024 Aug 24;24(1):701. doi: 10.1186/s12877-024-05307-4.
The aim of this study was to describe a population of very old people with heart failure (HF), to analyse the use of cardiovascular drugs over time, and to explore factors influencing cardiovascular drug treatment for this group.
All participants with information regarding HF diagnosis were selected from the Umeå 85+/Gerontological Regional Database (GERDA). The people in GERDA are all ≥85 years old. Trained investigators performed structured interviews and assessments. Information regarding medications and diagnoses was obtained from the participants and from medical records. Medical diagnoses were reviewed and confirmed by an experienced geriatrician.
In this very old population, the prevalence of HF was 29.6% among women and 30.7% among men. Between 2000 and 2017, there was an increase in the use of renin-angiotensin (RAS) inhibitors (odds ratio [OR] 1.107, 95% confidence interval [CI] 1.072-1.144) and beta-blockers (BBs) (OR 1.123, 95% CI 1.086-1.161) among persons with HF, whereas the prevalence of loop diuretics (OR 0.899, 95% CI 0.868-0.931) and digitalis (OR 0.864, 95% CI 0.828-0.901) decreased (p < 0.001 for all drug classes). Higher age was associated with lower use of RAS inhibitors and BBs.
In this HF population, the use of evidence-based medications for HF increased over time. This may be a sign of better awareness among prescribers regarding the under-prescribing of guidelines-recommended treatment to old people. Higher age associated with a lower prevalence of RAS inhibitors and BBs. This might indicate that further improvement is possible but could also represent a more cautious prescribing among frail very old individuals.
本研究旨在描述一个心力衰竭（HF）高龄人群，并分析随着时间的推移心血管药物的使用情况，探索影响该人群心血管药物治疗的因素。
从于默奥 85 岁以上/老年区域数据库（GERDA）中选择所有有心力衰竭诊断信息的参与者。GERDA 中的所有人都≥85 岁。经过培训的调查员进行了结构化访谈和评估。药物和诊断信息从参与者和医疗记录中获得。医疗诊断由一名经验丰富的老年病医生进行审查和确认。
在这个非常高龄的人群中，女性心力衰竭的患病率为 29.6%，男性为 30.7%。在 2000 年至 2017 年间，心力衰竭患者中肾素-血管紧张素（RAS）抑制剂（比值比 [OR] 1.107，95%置信区间 [CI] 1.072-1.144）和β受体阻滞剂（BBs）（OR 1.123，95%CI 1.086-1.161）的使用率增加，而袢利尿剂（OR 0.899，95%CI 0.868-0.931）和地高辛（OR 0.864，95%CI 0.828-0.901）的使用率下降（所有药物类别 p < 0.001）。较高的年龄与 RAS 抑制剂和 BBs 的使用率降低相关。
在这个心力衰竭人群中，随着时间的推移，心力衰竭的证据基础药物的使用有所增加。这可能表明，医生对老年人指南推荐治疗方案的处方不足的认识有所提高。较高的年龄与 RAS 抑制剂和 BBs 的较低使用率相关。这可能表明，进一步改善是可能的，但也可能代表脆弱的非常高龄个体更谨慎的处方。
