A study of the influence of the guideline on the treatment of chronic congestive heart failure in the elderly

Abstract

To investigate the changes in drug treatment in elderly inpatients with chronic congestive heart failure (CHF) after the publication of the guideline. Three thousands one hundred and seventy-four hospitalized patients over 60 years old with CHF admitted from January 1990 to July 2007 to Second Hospital of Tianjin Medical University were enrolled, and the patients were divided into three groups according to every 6 years by the time when guideline of the American College of Cardiology/American Heart Association (ACC/AHA) was published. The changes in drug treatment were analyzed retrospectively. The proportion of enrolled patients was 79.2% (3 174/4 010) of total number of CHF patients. The number of male patients was 1 639, and that of the female 1 535. The age ranged 60-98 years old with the mean age (71.94±7.07) years old. Three groups were from 1990 to 1995 (group A), from 1996 to 2001 (group B) and from 2002 to 2007 (group C) respectively. The patients' age (years old) of three groups increased year by year (mean age of each group was 68.99±6.71, 71.56±6.86, 73.79±7.01 respectively, F=91.142, P<0.01). The three major causes of heart failure were coronary heart disease (55.3%, 64.5%, 81.8%), pulmonary heart disease (21.9%, 19.3%,5.5%) and rheumatic heart disease (16.5%, 10.3%, 7.5%). The difference among the three causes was statistically significant (χ(2)=217.979, P<0.01 ). Cardiac function on admission was mostly New York Heart Association (NYHA) grade III or IV (1 561 cases of NYHA III, 1 433 cases of NYHA IV, χ(2)=75.828, P<0.01 ). The outcome was mostly improved (the proportion of three groups was 88.9%, 88.3%, 92.7%, respectively, χ(2)=35.002, P<0.01). The frequency of using nitrate esters, β-blocker, angiotensin receptor blocker (ARB), aldosterone antagonist was increased year by year (all P<0.05). The use of digitalis was decreased gradually (both P<0.05). The angiotensin converting enzyme inhibitor (ACEI) and β-blocker were mostly used in coronary heart disease, and their frequency was 81.3% (1 698/2 088) and 87.8% (768/875) respectively. The guidelines made positive effects on the treatment of elderly inpatients with CHF. The treatment drugs that can improve the prognosis of CHF should be used in this group in time.