Retrospective investigation of pharmacologic management in elderly inpatients with chronic heart failure / 中华老年医学杂志

ABSTRACT

Objective To understand the practical application of drug intervention in elderly patients with chronic heart failure (CHF) for providing evidences and data for a standard treatment. Methods The elderly CHF patients aged at least 60 years who were hospitalized from July 1973 toJuly 2007 in the Second Hospital of Tianjin Medical University and from January 1983 to December 2002 in Tianjin First Center Hospital were enrolled. The age, gender, etiology, heart function and drug therapy were retrospectively analyzed. The patients were divided into 4 groups group 1973-,group 1980-, group 1990- and group 2000-2007. And the data were collected and analyzed by SPSS 13.0 software. Results A total of 4704 cases were enrolled, of which there were 2430 (51.7%)male and 2274 (48. 3%) female. Mean age was (71.3±-7. 1) years. The patients aged 80 years andover accounted for 12.8% (603/4704). The first three ranking causes were pulmonary heart disease,coronary heart disease and rheumatoid heart disease in group 1973- and 1980-. And those were coronary heart disease, pulmonary heart disease and rheumatoid heart disease in group 1990 and 2000-2007. The combined uses of angiotension converting enzyme inhibitors(ACEI) and β-receptor blocker,and of ACEI, β-receptor blocker and aldosterone antagonist were also increasing year by year. Patients with coronary heart disease, rheumatoid heart disease, pulmonary heart disease and dilated cardiomyopathy had a higher proportion of multiple drugs cotreatment. The differences in the frequency of all drugs use among four groups of CHF had a statistical significance (p＜0.05). The usage of ACEI combined with β-receptor blocker and aldosterone antagonist, and ACEI combined withβ-receptor blocker, diuretic and digitalis was increasing along with the heart function becoming serious. The patients with a heart function of New York Heart Association (NYHA) Ⅱ or Ⅲ class received more β-receptor blocker. And ACEI was used at most in patients with NYHA Ⅲ class. The angiotension Ⅱ receptor blockers(ARB) was used at most in NYHA Ⅲ or Ⅳ class. Conclusions Nitrate, diuretic and digitalis are the main therapeutic agents in hospitalized patients with CHF in some regions of Tianjin. ACEI, β-receptor blocker and ARB are used in a rapid increment. There are still some problems such as standardizing the heart failure treatment and prevention in the elderly.