Cardiovascular drug use among people with cognitive impairment living in nursing homes in northern Sweden

Sofia Svahn,Per-Olof Sandman,Maria Gustafsson,Hugo Lövheim,Ulf Isaksson

doi:10.1007/s00228-019-02778-y

Abstract

PurposeThe aim of this study was to describe changes in the pattern of cardiovascular agents used in elderly people living in nursing homes between 2007 and 2013. Further, the aim was to analyse the use of cardiovascular drugs in relation to cognitive impairment and associated factors within the same population, where prescription of loop diuretics was used as a proxy for heart failure.MethodsTwo questionnaire surveys were performed including 2494 people in 2007 and 1654 people in 2013 living in nursing homes in northern Sweden. Data were collected concerning drug use, functioning in activities of daily living (ADL) and cognition, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The use of different drugs and drug classes among people at four different levels of cognitive function in 2007 and 2013 were compared.ResultsThe proportion of people prescribed ASA and diuretics was significantly lower at all four levels of cognitive function in 2013 compared to 2007. Among people prescribed loop diuretics, the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs) increased from 37.8 to 45.6%, β-blockers from 36.0 to 41.8% and warfarin from 4.4 to 11.4%. The use of warfarin, ACEI/ARBs, β-blockers and mineralocorticoid receptor antagonists (MRAs) were less common among individuals with more severe cognitive impairment.ConclusionThe results indicate that cardiovascular drug treatment has improved between 2007 and 2013, but there is room for further improvement, especially regarding adherence to guidelines for heart failure. Increasing cognitive impairment had an effect on treatment patterns for heart failure and atrial fibrillation.

Highlights

IntroductionCardiovascular disease, leading to about one-third of all deaths globally, is the most common cause of mortality [1]
Cardiovascular disease, leading to about one-third of all deaths globally, is the most common cause of mortality [1].87 Umeå, Sweden 5 Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, SE-171 77 Stockholm, SwedenUntreated hypertension is an important risk factor in developing heart failure, ischaemic heart disease, stroke, atrial fibrillation, chronic kidney disease and peripheral arterial disease, and it has been associated with a higher risk of cognitive decline [2]
The aim was to analyse the use of cardiovascular drugs in relation to cognitive impairment and associated factors within the same population, where prescription of loop diuretics was used as a proxy for heart failure

Summary

Introduction

Cardiovascular disease, leading to about one-third of all deaths globally, is the most common cause of mortality [1]. Untreated hypertension is an important risk factor in developing heart failure, ischaemic heart disease, stroke, atrial fibrillation, chronic kidney disease and peripheral arterial disease, and it has been associated with a higher risk of cognitive decline [2]. Hypertension is a common condition with more than one billion people affected worldwide. The prevalence of systolic hypertension increases with age [4], but might be declining again in very advanced age [5]. As mentioned above, untreated hypertension can cause heart failure. The prognosis for people with heart failure is poor, and the rates of hospital admissions and mortality are high [7]. Even though heart failure is a disease with high prevalence in the elderly, these people are often

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