Journal article
Age and Receipt of Guideline-Recommended Medications for Heart Failure: A Nationwide Study of Veterans
Journal of general internal medicine : JGIM, Vol.26(10), pp.1152-1159
10/2011
DOI: 10.1007/s11606-011-1745-2
PMCID: PMC3181303
PMID: 21604076
Abstract
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.
Details
- Title: Subtitle
- Age and Receipt of Guideline-Recommended Medications for Heart Failure: A Nationwide Study of Veterans
- Creators
- Michael A Steinman - Health Services Research Enhancement Award Program (REAP), San Francisco VA Medical Center, 4150 Clement St, VA Box 181 G, San Francisco, CA 94121 USAJohn B Harlow - Division of Geriatrics, San Francisco VA Medical Center and the University of California San Francisco, San Francisco, CA USABarry M Massie - Division of Cardiology, San Francisco VA Medical Center and the University of California San Francisco, San Francisco, CA USAPeter J Kaboli - The Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, Iowa City, IA USAKathy Z Fung - Division of Geriatrics, San Francisco VA Medical Center and the University of California San Francisco, San Francisco, CA USAPaul A Heidenreich - Veterans Health Administration Congestive Heart Failure Quality Enhancement Research Initiative, Washington, DC USA
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.26(10), pp.1152-1159
- DOI
- 10.1007/s11606-011-1745-2
- PMID
- 21604076
- PMCID
- PMC3181303
- NLM abbreviation
- J Gen Intern Med
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Publisher
- Springer-Verlag
- Language
- English
- Date published
- 10/2011
- Academic Unit
- Epidemiology; Internal Medicine
- Record Identifier
- 9984094557902771
Metrics
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