BACKGROUND: Older patients often receive less guideline-concordant care for heart failure than younger patients. OBJECTIVE: To determine whether age differences in heart failure care are explained by patient, provider, and health system characteristics and/or by chart-documented reasons for non-adherence to guidelines. DESIGN AND PATIENTS: Retrospective cohort study of 2,772 ambulatory veterans with heart failure and left ventricular ejection fraction <40% from a 2004 nationwide medical record review program (the VA External Peer Review Program). MAIN MEASURES: Ambulatory use of ACE inhibitors, angiotensin receptor blockers (ARBs), and beta blockers. RESULTS: Among 2,772 patients, mean age was 73 +/- 10 years, 87% received an ACE inhibitor or ARB, and 82% received a beta blocker. When patients with explicit chart-documented reasons for not receiving these drugs were excluded, 95% received an ACE inhibitor or ARB and 89% received a beta blocker. In multivariable analyses controlling for a variety of patient and health system characteristics, the adjusted odds ratio for ACE-inhibitor and ARB use was 0.43 (95% CI 0.24-0.78) for patients age 80 and over vs. those age 50-64 years, and the adjusted odds ratio for beta blocker use was 0.66 (95% CI 0.48-0.93) between the two age groups. The magnitude of these associations was similar but not statistically significant after excluding patients with chart-documented reasons for not prescribing ACE inhibitors or ARBs and beta blockers. CONCLUSIONS: A high proportion of veterans receive guideline-recommended medications for heart failure. Older veterans are consistently less likely to receive these drugs, although these differences were no longer significant when accounting for patients with chart-documented reasons for not prescribing these drugs. Closely evaluating reasons for non-prescribing in older adults is essential to assessing whether non-treatment represents good clinical judgment or missed opportunities to improve care.
BACKGROUND: Older patients often receive less guideline-concordant care for heart failure than younger patients. OBJECTIVE: To determine whether age differences in heart failure care are explained by patient, provider, and health system characteristics and/or by chart-documented reasons for non-adherence to guidelines. DESIGN AND PATIENTS: Retrospective cohort study of 2,772 ambulatory veterans with heart failure and left ventricular ejection fraction <40% from a 2004 nationwide medical record review program (the VA External Peer Review Program). MAIN MEASURES: Ambulatory use of ACE inhibitors, angiotensin receptor blockers (ARBs), and beta blockers. RESULTS: Among 2,772 patients, mean age was 73 +/- 10 years, 87% received an ACE inhibitor or ARB, and 82% received a beta blocker. When patients with explicit chart-documented reasons for not receiving these drugs were excluded, 95% received an ACE inhibitor or ARB and 89% received a beta blocker. In multivariable analyses controlling for a variety of patient and health system characteristics, the adjusted odds ratio for ACE-inhibitor and ARB use was 0.43 (95% CI 0.24-0.78) for patients age 80 and over vs. those age 50-64 years, and the adjusted odds ratio for beta blocker use was 0.66 (95% CI 0.48-0.93) between the two age groups. The magnitude of these associations was similar but not statistically significant after excluding patients with chart-documented reasons for not prescribing ACE inhibitors or ARBs and beta blockers. CONCLUSIONS: A high proportion of veterans receive guideline-recommended medications for heart failure. Older veterans are consistently less likely to receive these drugs, although these differences were no longer significant when accounting for patients with chart-documented reasons for not prescribing these drugs. Closely evaluating reasons for non-prescribing in older adults is essential to assessing whether non-treatment represents good clinical judgment or missed opportunities to improve care.
Authors: Frederick A Masoudi; Edward P Havranek; Grace Smith; Ronald H Fish; John F Steiner; Diana L Ordin; Harlan M Krumholz Journal: J Am Coll Cardiol Date: 2003-01-15 Impact factor: 24.094
Authors: Nicholas L Smith; Jeannie D Chan; Thomas D Rea; Kerri L Wiggins; John S Gottdiener; Thomas Lumley; Bruce M Psaty Journal: Am Heart J Date: 2004-10 Impact factor: 4.749
Authors: Frederick A Masoudi; Saif S Rathore; Yongfei Wang; Edward P Havranek; Jeptha P Curtis; JoAnne Micale Foody; Harlan M Krumholz Journal: Circulation Date: 2004-08-02 Impact factor: 29.690
Authors: Prakash C Deedwania; Stephen Gottlieb; Jalal K Ghali; Finn Waagstein; John C M Wikstrand Journal: Eur Heart J Date: 2004-08 Impact factor: 29.983
Authors: Alain G Bertoni; Vanessa Duren-Winfield; Walter T Ambrosius; Jill McArdle; Carla A Sueta; Mark W Massing; Sharon Peacock; Jennifer Davis; Janet B Croft; David C Goff Journal: Am J Cardiol Date: 2004-03-15 Impact factor: 2.778
Authors: Michael W Smith; Charnetta Brown; Salim S Virani; Charlene R Weir; Laura A Petersen; Natalie Kelly; Julia Akeroyd; Jennifer H Garvin Journal: Appl Clin Inform Date: 2018-06-27 Impact factor: 2.342
Authors: Michael A Steinman; Liezel Dimaano; Carolyn A Peterson; Paul A Heidenreich; Sara J Knight; Kathy Z Fung; Peter J Kaboli Journal: Med Care Date: 2013-10 Impact factor: 2.983
Authors: Olga V Patterson; Matthew S Freiberg; Melissa Skanderson; Samah J Fodeh; Cynthia A Brandt; Scott L DuVall Journal: BMC Cardiovasc Disord Date: 2017-06-12 Impact factor: 2.298