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Use of Angiotensin-Converting Enzyme Inhibitors in Elderly People With Heart Failure: Prevalence and Outcomes

¹ Centro di Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Roma, Italy.
² Sticht Center on Aging, Wake Forest University Baptist Medical Center, North Carolina.

Address correspondence to Claudio Pedone, MD, MPH, Centro di Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, 00168 Rome, Italy. E-mail: claudio_pedone{at}rm.unicatt.it

Background. There is a lack of information on the effects of angiotensin-converting enzyme (ACE) inhibitors in very old people with heart failure (HF). The objective of this study is to estimate the prevalence of prescriptions of ACE inhibitors in elderly people with HF discharged from acute care hospitals, and to evaluate the effect of these drugs on 1-year mortality rates.

Methods. We used data from the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA). In 1998, we undertook a 1-year longitudinal study on elderly people (aged 65+ years) discharged with a diagnosis of HF. We compared the demographic and clinical characteristics associated with a prescription at discharge of ACE inhibitors, and used a Cox proportional hazard regression model to calculate the relative hazard of dying associated with the use of ACE inhibitors.

Results. We enrolled 818 patients in the study with a mean age of 79 years (range: 65–101 years). One fourth of the participants were aged 85 years or older. ACE inhibitors were prescribed to 550 patients (67.2%) at discharge. Older age and physical disability were negatively correlated with the use of ACE inhibitors. People using ACE inhibitors had a 40% reduction of mortality (HR [hazard ratio]: 0.60; 95% CI [confidence intervals]: 0.42–0.88). The reduction in mortality was much stronger among disabled people (HR: 0.35; 95% CI: 0.19–0.64).

Conclusion. ACE inhibitors are still underprescribed among elderly people with HF discharged from acute care hospitals. Even in this frail, elderly population, we found a beneficial effect of ACE inhibitors. There is room to further improve the quality of care for elderly people with HF.