Department of Medical and Translational Biology, Umeå University, Umeå, Sweden.
Drugs Aging. 2024 Nov;41(11):907-913. doi: 10.1007/s40266-024-01153-6. Epub 2024 Nov 3.
Comorbidities are common among older people, and during the last decade, a strong association between heart failure (HF) and cognitive impairment has been found. As much as 40-50% of individuals with HF will also have some degree of cognitive impairment. Previous studies report an undertreatment for some cardiovascular diseases in patients with major neurocognitive disorder (NCD).
The aim of this present study was to explore differences in pharmacological treatment of HF in individuals diagnosed with HF with or without comorbidity of major NCD.
This study combined data from three different Swedish national registers: the Swedish National Patient Register, the Swedish registry for cognitive/dementia disorders (SveDem), and the Swedish Prescribed Drug Register. A logistic regression model including variables for age, sex, major NCD, and nursing home residency was used to analyze associations between drug use and major NCD.
We found a lower prevalence of filled prescriptions of renin-angiotensin system (RAS) inhibitors, β-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs) among patients with major NCD. Living in a nursing home was associated with lower prevalence of RAS inhibitors, BBs, digitalis glycosides, and sodium-glucose cotransporter-2 (SGLT2) inhibitors. Females were found to have higher odds of using BBs, loop diuretics and digitalis glycosides, and lower odds of using RAS inhibitors and SGLT2 inhibitors than males.
Our findings indicate that there is possible undertreatment among individuals with HF identified in specialized care with co-occurring major NCD. Major NCD was associated with less filled prescriptions of basal pharmacological treatments such as RAS inhibitors, BBs, and MRAs. Future research needs to not only investigate this relationship further but also focus on reasons for the undertreatment of HF and other comorbidities within this group.
合并症在老年人中很常见，在过去十年中，心力衰竭（HF）和认知障碍之间存在很强的关联。多达 40-50%的 HF 患者也会有一定程度的认知障碍。先前的研究报告称，在患有主要神经认知障碍（NCD）的患者中，一些心血管疾病的治疗不足。
本研究旨在探讨诊断为 HF 合并或不合并主要 NCD 的患者在 HF 药物治疗方面的差异。
本研究结合了来自三个不同的瑞典国家登记处的数据：瑞典国家患者登记处、瑞典认知/痴呆障碍登记处（SveDem）和瑞典处方药物登记处。使用包括年龄、性别、主要 NCD 和疗养院居住情况的变量的逻辑回归模型来分析药物使用与主要 NCD 之间的关联。
我们发现，患有主要 NCD 的患者中，肾素-血管紧张素系统（RAS）抑制剂、β-受体阻滞剂（BBs）和盐皮质激素受体拮抗剂（MRAs）的处方使用率较低。居住在疗养院与 RAS 抑制剂、BBs、地高辛糖苷和钠-葡萄糖共转运蛋白-2（SGLT2）抑制剂的使用率较低有关。与男性相比，女性使用 BBs、袢利尿剂和地高辛糖苷的几率更高，使用 RAS 抑制剂和 SGLT2 抑制剂的几率更低。
我们的研究结果表明，在专门护理中识别出的合并主要 NCD 的 HF 患者可能存在治疗不足的情况。主要 NCD 与基础药物治疗（如 RAS 抑制剂、BBs 和 MRAs）的处方使用率较低有关。未来的研究不仅需要进一步调查这种关系，还需要关注这一人群中 HF 和其他合并症治疗不足的原因。
