Quality of care in congestive heart failure in the elderly: epidemiological evidence of a gap between guidelines and clinical practice
Stefano Brocco1, Mauro Zamboni2, Francesco Fantin2, Maria Marchesan1, Elena Schievano1, Francesco Zambon1, Chiara Bozzano2, Vincenzo Di Francesco2, Corrado Vassanelli3 and Paolo Spolaore1
1Epidemiological Department, Veneto Region, Castelfranco Veneto, 2Division of Geriatric Medicine, University of Verona, 3Division of Cardiology, University of Verona, Italy

Background and aims: This study aimed at evaluating the quality of care in elderly patients hospitalized for heart failure, compared with that received by subjects of younger age. Methods: A cross-sectional retrospective study was performed on hospitalized subjects for heart failure in the Veneto Region (4.5 million inhabitants), located in North-East Italy, for the year 2004. Through consultation of clinical charts, performance of echocardiography, and prescription of ACE-inhibitors and β-blockers were evaluated in each patient. Multivariate statistical analysis was used to test the association between age and the end-points of interest: prescription of ACE-inhibitors or β-blockers and performance of echocardiography. Results: The percentage of patients with prescriptions for ACE-inhibitors decreased with age, from 75% for patients under 65 years, to 62% for subjects over 84 years (p=0.02). A similar, but more marked, finding was observed for prescriptions of β-blockers (56% in subjects aged <65 yrs vs 16% in those aged >84 yrs) (p<0.001). Evaluation of echocardiography was performed in 61% of subjects under 65 and in 22% in those over 84 (p<0.001). After statistical adjustment, age remained a significant predictor of prescription for β-blockers and performance of echocardiography, but no longer for prescription of ACE-inhibitors. Conclusions: Among the elderly, age was a negative predictor of β-blocker prescription and echocardiographic evaluation, but did not affect prescriptions for ACE-inhibitors. (Aging Clin Exp Res 2010; 22: 243-248) ©2010, Editrice Kurtis

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