02912nas a2200337 4500008004100000022001400041245015700055210006900212260001600281300001200297490000800309520192700317653000902244653004502253653002102298653001102319653001802330653001102348653002002359653000902379653001802388653002202406653001802428100001502446700001502461700001202476700001202488700002002500700001802520856003602538 1998 eng d a0003-992600aTemporal patterns in the medical treatment of congestive heart failure with angiotensin-converting enzyme inhibitors in older adults, 1989 through 1995.0 aTemporal patterns in the medical treatment of congestive heart f c1998 May 25 a1074-800 v1583 a

BACKGROUND: Evidence from clinical trials in the past decade has consistently shown that angiotensin-converting enzyme (ACE) inhibitors reduce morbidity and mortality in patients with congestive heart failure (CHF). The extent to which clinical practice has adopted ACE inhibitor therapy is unknown.

METHODS: The Cardiovascular Health Study is a prospective observational study of 5201 community-dwelling adults aged 65 years and older. Prevalent CHF cases were identified on study entry (from June 10, 1989, through May 31, 1990) and incident CHF cases were identified throughout 5 years of follow-up. Medication data were collected from annual medication inventories. The percentage of patients with CHF using ACE inhibitors was calculated at each annual examination. Temporal trends in CHF treatment with ACE inhibitors between June 10, 1989, through May 31, 1990, and June 1, 1994, through May 31, 1995, were analyzed.

RESULTS: Use of ACE inhibitors to treat CHF increased slightly over time among prevalent cases at each annual examination: 26% of prevalent CHF cases were treated in 1989-1990 compared with 36% of prevalent cases in 1994-1995. This 10% increase was statistically significant (P<.01). Participants with low ejection fractions were 2 times more likely to be treated with ACE inhibitors than were those with normal ejection fraction and this tendency did not change over time. Among cases newly diagnosed in the year before the 1990-1991 examination, 42% were using ACE inhibitors; among those newly diagnosed in the year before 1994-1995, 40% were using ACE inhibitors. This 2% decrease was not statistically significant (P=.68).

CONCLUSION: These findings suggest that, while the medical management of CHF with ACE inhibitors has increased modestly over time in prevalent cases, these drugs may still be underused, especially among incident cases.

10aAged10aAngiotensin-Converting Enzyme Inhibitors10aDrug Utilization10aFemale10aHeart Failure10aHumans10aLogistic Models10aMale10aStroke Volume10aTreatment Outcome10aUnited States1 aSmith, N L1 aPsaty, B M1 aPitt, B1 aGarg, R1 aGottdiener, J S1 aHeckbert, S R uhttps://chs-nhlbi.org/node/150703552nas a2200469 4500008004100000022001400041245015000055210006900205260001600274300001000290490000700300520219200307653000902499653002202508653002502530653002802555653003002583653001102613653001802624653001802642653001102660653002002671653002502691653000902716653001502725653001702740653003102757653001802788653003102806100001802837700001602855700002002871700001402891700001502905700001702920700001702937700001302954700001502967700001802982710004703000856003503047 2001 eng d a0002-914900aImportance of heart failure with preserved systolic function in patients > or = 65 years of age. CHS Research Group. Cardiovascular Health Study.0 aImportance of heart failure with preserved systolic function in  c2001 Feb 15 a413-90 v873 a

Although congestive heart failure (CHF) is a common syndrome among the elderly, there is a relative paucity of population-based data, particularly regarding CHF with normal systolic left ventricular function. A total of 4,842 independent living, community-dwelling subjects aged 66 to 103 years received questionnaires on medical history, family history, personal habits, physical activity, and socioeconomic status, confirmation of pre-existing cardiovascular and cerebrovascular disease, anthropometric measurements, casual seated random-zero blood pressure, forced vital capacity and expiratory volume in 1 second, 12-lead supine electrocardiogram, fasting glucose, creatinine, plasma lipids, carotid artery wall thickness by ultrasonography, and echocardiography-Doppler examinations. Participants with at least 1 confirmed episode of CHF by Cardiovascular Health Study criteria were considered prevalent for CHF. The prevalence of CHF was 8.8% and was associated with increased age, particularly for women, in whom it increased more than twofold from age 65 to 69 years (6.6%) to age > or = 85 years (14%). In multivariate analysis, subjects with CHF were more likely to be older (odds ratio [OR] 1.2 for 5-year difference, men OR 1.1), and more often had a history of myocardial infarction (OR 7.3), atrial fibrillation (OR 3.0), diabetes mellitus (OR 2.1), renal dysfunction (OR 2.0 for creatinine < or = 1.5 mg/ dl), and chronic pulmonary disease (OR 1.8; women only). The echocardiographic correlates of CHF were increased left atrial and ventricular dimensions. Importantly, 55% of subjects with CHF had normal left ventricular systolic function and 80% had either normal or only mildly reduced systolic function. Among subjects with CHF, women had normal systolic function more frequently than men (67% vs 42%; p < 0.001). Thus, CHF is common among community-dwelling elderly. It increases with age and is usually associated with normal systolic LV function, particularly among women. The finding that a large proportion of elderly with CHF have preserved LV systolic function is important because there is a paucity of data to guide management in this dominant subset.

10aAged10aAged, 80 and over10aAnalysis of Variance10aChi-Square Distribution10aEchocardiography, Doppler10aFemale10aHealth Status10aHeart Failure10aHumans10aLogistic Models10aLongitudinal Studies10aMale10aPrevalence10aRisk Factors10aSurveys and Questionnaires10aUnited States10aVentricular Function, Left1 aKitzman, D, W1 aGardin, J M1 aGottdiener, J S1 aArnold, A1 aBoineau, R1 aAurigemma, G1 aMarino, E, K1 aLyles, M1 aCushman, M1 aEnright, P, L1 aCardiovascular Health Study Research Group uhttps://chs-nhlbi.org/node/632