Evaluating heart failure treatment in the elderly patients in primary care

Background: Despite the fact that heart failure (HF) constitutes a major health problem there are only limited data regarding pharmacotherapy along with the profile and prognosis of HF in the community. The aim of this study was to investigate treatment patterns in ambulatory patients with HF. Material and methods: The study is a cross-country epidemiological survey, based on registration of 50 consecutive ambulatory patients aged ≥ 65 years. Data from case history, physical examination, lab test results, diagnosis of HF and medication prescribed, were recorded in questionnaires. Results: From a total of 19877 individuals, 10579 patients (3901 men and 6678 women, 53% of the total) were diagnosed with HF. Therapy with angiotensin converting enzyme inhibitors (ACEI) was recommended in 68%, long acting nitrates (NTG) in 62%, diuretics in 55%, cardiac glycosides in 31%, calcium antagonists in 29% and b-blockers in 22% of all individuals with HF. The prevalence of particular groups of drugs administered in both genders were similar with the exception for calcium antagonists, which were more frequently used in women (p < 0.001), whereas NTG in men (p < 0.001). In general, ACEI, NTG and digoxin use increased with age. On the contrary, beta-blockers and calcium antagonists were prescribed mostly to younger patients. The most severely ill patients were more likely to receive ACEI, cardiac glycosides, NTG and diuretics, and less likely to receive b-blockers and calcium antagonists. Combination therapy was used relatively rarely, with the lowest percentage in NYHA IV. Conclusions: Compared to the other population studies, both ACEI and b-blockers were used more frequently, although in the absolute terms the latter were clearly underused. The high rate