Drug treatment of heart failure--do nursing-home residents deserve better?

OBJECTIVE: To describe and assess drug treatment of heart failure (HF) in nursing-home residents.
DESIGN: Descriptive cross-sectional study. Individual patient information was obtained from the medical records and drug-dispensing cards.
SETTING: Nursing homes in Bergen, Norway. MAIN OUTCOME MEASURES: Demographic data, diagnostic data (main diagnoses, diagnostic indications for the drugs used), medications (drugs, dosage and duration of use).
RESULTS: Data were gathered from 23 of 27 obtainable institutions representing 1552 residents (86% of the Bergen nursing-home population); 469 (30%) of the residents used drugs for HF, the majority of whom (293 patients) were treated with furosemide only. Supplementary angiotensin-converting enzyme (ACE) inhibitors (predominantly in sub-target doses) were provided to 17% of the HF patients. About one out of four used drug combinations which we considered to be potentially harmful for HF patients.
CONCLUSIONS: ACE inhibitors are probably under-utilised for HF in nursing-home residents. Potentially harmful drug combinations commonly occur. Both diagnosis and drug treatment for HF should be challenged in the nursing-home setting.