Abstract
Background
The prevalence of cardiovascular diseases among nursing home residents is high but
little is known whether pharmacologic therapy recommended by actual medication guidelines
is followed by facility's staff.
Aim
To evaluate the adherence to actual guidelines for treatment of cardiovascular diseases
among older adult residents of long-term care (LTC) facilities.
Material and methods
The cross-sectional study was performed from December 2009 to November 2010 among
189 elderly residents aged ≥60 years in 3 LTC facilities in Poland: 1 long-term care
hospital (LTCH) and 2 nursing homes (NHs). The initial evaluation included analysis
of medical documentation (all diagnosed diseases and used drugs), blood pressure (BP)
measurements and performance of Mini Nutritional Assessment Short-Form (MNA-SF), Abbreviated
Mental Test Score (AMTS), Activities of Daily Living (ADL) score, and Barthel Index.
Prescribed medication for hypertension (HT), heart failure (HF), and coronary heart
disease (CHD) were compared to current European Cardiology Society (ESC), and European
Society of Hypertension (ESH) medication guidelines. Residents were divided into 3
subgroups: with HT, HF, and CHD. Results were presented as means and standard deviation.
Groups were compared using Mann-Whitney U test for nonparametric data and chi-square test to assess differences in distribution
of categorical variables. P values <.05 were considered statistically significant.
Results
CHD was diagnosed among 114 residents (60.3%) but only 60.5% of them were treated
with aspirin (ASA), 45.6% with beta-blockers (BBs), 60.5% with angiotensin-converting
enzyme inhibitor (ACEI), and 24.6% with statins. HF observed in 75% of cases was treated
by using ACEI (54.7%), BBs (45.3%), loop diuretics (LDs, 36%), mineralocorticoid-receptor
antagonists (MRAs, 21.3%). HT was diagnosed among 98 study participants (51.9%) and
in the majority of cases (76.6%) was well controlled (mean BP: 133.7 ± 17.6/73.8 ±
10.2 mmHg). The most popular antihypertensive drugs were ACEIs (77.6%), BBs (40.8%)
and calcium channel blockers (CCBs, 26.5%) whereas thiazides, alpha-blockers (ABs),
and angiotensin receptor blockers (ARBs) were used less frequently.
Conclusion
In summary, the study showed that insufficient treatment of cardiovascular diseases
among elderly residents of LTC facilities could be a potential risk factor of poor
prognosis.
Keywords
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References
- The burden of cardiovascular disease in the elderly: Morbidity, mortality, and costs.Clin Geriatr Med. 2009; 25: 563-577
- Cardiovascular diseases.(Available at:)http://www.who.int/mediacentre/factsheets/fs317/en/Date accessed: September 26, 2017
- European Cardiovascular Disease Statistics 2017.(Available at:)http://www.ehnheart.org/cvd-statistics.htmlDate accessed: September 26, 2017
- Potentially inappropriate medication use among elderly home care patients in Europe.JAMA. 2005; 293: 1348-1358
- Inappropriate medication in a national sample of US elderly patients receiving home health care.J Gen Intern Med. 2012; 27: 304-310
- Use of potentially inappropriate drugs in nursing homes.Pharmacotherapy. 2002; 22: 88-96
- An expert opinion from the European Society of Hypertension–European Union Geriatric Medicine Society Working Group on the Management of Hypertension in Very Old, Frail Subjects.Hypertension. 2016; 67: 820-825
- Nursing home and nursing home physician: The Dutch experience.J Am Med Dir Assoc. 2004; 5: 207-212
- The treatment of hypertension in care home residents: A systematic review of observational studies.J Am Med Dir Assoc. 2014; 15: 8-16
- 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension.J Hypertens. 2013; 31: 1925-1938
- 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).J Hypertens. 2013; 31: 1281-1357
- Validation of the Mini Nutritional Assessment Short-Form (MNA-SF): A practical tool for identification of nutritional status.J Nutr Health Aging. 2009; 13: 782-788
- Evaluation of a mental test score for assessment of mental impairment in the elderly.Age Ageing. 1972; 1: 233-238
- Studies of illness in the aged: The index of ADL: A standardized measure of biological and psychosocial function.JAMA. 1963; 185: 914-919
- Functional evaluation: The Barthel Index.Md State Med J. 1965; 14: 61-65
- Heart failure in elderly: Progress in clinical evaluation and therapeutic approach.J Geriatr Cardiol. 2013; 10: 165-177
- A randomized trial of intensive versus standard blood-pressure control.N Engl J Med. 2015; 373: 2103-2116
- Polypharmacy in the aging patient: Management of hypertension in octogenarians.JAMA. 2015; 314: 170-180
- Heart failure in nursing home residents; A cross-sectional study to determine the prevalence and clinical characteristics.BMC Geriatr. 2015; 15: 167
- The health of elderly residents in long term care institutions in New Zealand.N Z Med J. 1999; 112: 427-429
- Treatment of heart failure in nursing home residents.J Geriatr Cardiol. 2016; 13: 44-50
- 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.Eur Heart J. 2016; 37 (Erratum in: Eur Heart J 2016 Dec 30): 2129-2200
- High prevalence of undetected heart failure in long-term care residents: Findings from the Heart Failure in Care Homes (HFinCH) study.Eur J Heart Fail. 2013; 15: 158-165
- Prevalence of heart failure in nursing homes: A systematic literature review.Scand J Caring Sci. 2010; 24: 202-208
- Heart failure: Recent advances in prevention and treatment.Rev Cardiovasc Med. 2000; 1 (54): 25-33
- Patients' persistence of evidence-based treatment of chronic heart failure: A treatment paradox.Circulation. 2007; 116: 693-695
- Forecasting the future of cardiovascular disease in the United States: A policy statement from the American Heart Association.Circulation. 2011; 123: 933
- Patterns of pharmacologic treatment of congestive heart failure in elderly nursing home residents and related issues: A review of the literature.Clin Ther. 2003; 25: 1918-1935
- Prevalence and treatment of heart failure in Swedish nursing homes.BMC Geriatr. 2013; 13: 118
- Heart failure, comorbidities, and polypharmacy among elderly nursing home residents.Pol Arch Med Wewn. 2013; 123: 170-175
- Medication undertreatment in assisted living settings.Arch Intern Med. 2004; 164: 2031-2037
- Non-compliance in patients with heart failure; How can we manage it?.Eur J Heart Fail. 2005; 7: 5-17
- Advances in the non-drug, non-surgical, non-device management of chronic heart failure.Int J Cardiol. 2005; 100: 1-4
- FRAIL-HF, a study to evaluate the clinical complexity of heart failure in nondependent older patients: Rationale, methods and baseline characteristics.Clin Cardiol. 2014; 37: 725-732
- Self-management of heart disease in older adults.Home Health Care Serv Q. 2015; 34: 159-172
- 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology.Eur Heart J. 2013; 34 (Erratum in: Eur Heart J 2014;35:2260–2261): 2949-3003
Article info
Publication history
Published online: February 02, 2018
Footnotes
The authors declare no conflicts of interest.
The work was supported by the Ministry of Science and Higher Education (grant numbers N N404 047236).
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
