评估血管紧张素转换酶抑制剂在老年慢性心力衰竭疗养院居民中的使用情况。

Evaluating the use of angiotensin-converting enzyme inhibitors for older nursing home residents with chronic heart failure.

作者信息

Forman D E, Chander R B, Lapane K L, Shah P, Stoukides J

机构信息

The Miriam and Rhode Island Hospitals, Brown University, Providence 02906, USA.

出版信息

J Am Geriatr Soc. 1998 Dec;46(12):1550-4. doi: 10.1111/j.1532-5415.1998.tb01541.x.

DOI:10.1111/j.1532-5415.1998.tb01541.x

PMID:9848817

Abstract

BACKGROUND

Despite their well noted therapeutic benefits for heart failure (HF), angiotensin-converting enzyme (ACE) inhibitors may be underprescribed and underdosed among older nursing home patients.

OBJECTIVES

To assess the use of ACE inhibitor therapy in older (> or =70 years) nursing home residents with systolic heart failure (HF).

DESIGN

A cross-sectional, retrospective analysis.

SETTING

Five long-term care facilities in Providence, Rhode Island.

SUBJECTS

Adults aged 70 years or older with left ventricular (LV) ejection fractions < or =40%.

MEASUREMENTS

New York Heart Association (NYHA) class, comorbid diseases, and cardiac medications with logistic regression analysis to clarify their bearing on the prescription of ACE inhibitors.

RESULTS

Of the 819 nursing home residents who were evaluated, 119 (24 men, 95 women) fulfilled exacting entry criteria, i.e., heart failure signs/symptoms and documented LV systolic dysfunction. Forty-one of these 119 (35%) older persons were receiving ACE inhibitor therapy, predominantly in doses (< or =50 mg captopril/day or < or =5 mg enalapril/ day) less than those of proven therapeutic efficacy. Compared with older residents not receiving ACE inhibitors, those receiving ACE inhibitors included fewer with NYHA Class I HF (0 vs 21%, P = .017), more men (58 vs 28%, P< or =.01), and more people with hypertension (61 vs 35%, P< or =.01). In contrast, diuretics were prescribed more frequently among those not receiving ACE inhibitors (83 vs 56%, P< or =.001).

CONCLUSIONS

ACE inhibitors are underprescribed and underdosed among elderly nursing home patients carefully screened to include systolic HF and no contraindications to the medication. ACE inhibitors are particularly underused in those elderly with NYHA Class I HF and in those receiving diuretics.

摘要

背景

尽管血管紧张素转换酶（ACE）抑制剂对心力衰竭（HF）具有显著的治疗益处，但在老年疗养院患者中，其处方量可能不足且剂量偏低。

目的

评估血管紧张素转换酶抑制剂疗法在年龄≥70岁且患有收缩性心力衰竭（HF）的疗养院居民中的使用情况。

设计

横断面回顾性分析。

地点

罗德岛州普罗维登斯的五家长期护理机构。

研究对象

年龄≥70岁且左心室（LV）射血分数≤40%的成年人。

测量指标

纽约心脏协会（NYHA）心功能分级、合并疾病以及心脏药物使用情况，并通过逻辑回归分析来阐明它们对ACE抑制剂处方的影响。

结果

在接受评估的819名疗养院居民中，119名（24名男性，95名女性）符合严格的入选标准，即有心力衰竭体征/症状且有记录的左心室收缩功能障碍。这119名老年人中有41名（35%）正在接受ACE抑制剂治疗，主要剂量（卡托普利≤50mg/天或依那普利≤5mg/天）低于已证实的治疗有效剂量。与未接受ACE抑制剂治疗的老年居民相比，接受ACE抑制剂治疗的居民中NYHA I级心力衰竭患者较少（0%对21%，P = 0.017），男性较多（58%对28%，P≤0.01），高血压患者较多（61%对35%，P≤0.01）。相比之下，未接受ACE抑制剂治疗的患者中利尿剂的处方频率更高（83%对56%，P≤0.001）。