Abstract
OBJECTIVES: To evaluate the quality of care given to older patients hospitalised with heart failure and to identify areas in which treatment could be improved. METHODS: A two-year retrospective study involving the analysis of the case notes of a random sample of 145 elderly patients (aged 75 yrs) admitted to hospital with heart failure. From The International Classification of Diseases, we identified patients with a principle discharge diagnosis of heart failure (ICD codes 428.0-428.1-428.9). Cases were excluded if the diagnosis could not be validated by medical record review. A total of one hundred and forty five patients formed all the admissions with heart failure during the study period. The standard of care received was evaluated using the relevant quality of care indicators derived from the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines. RESULTS: The study sample included 145 patients. The mean age (SD) was 82 (5) years. Symptoms and signs of heart failure were documented in 145 (100%) patients. All patients with symptoms and signs of hypervolaemia received diuretic therapy. Only fifty-five patients (38%) had an objective assessment of left ventricular function by echocardiography. After exclusion of patients in whom Angiotensin Converting Enzyme (ACE) inhibitors were contraindicated, only seventy-five (58%) patients received ACE inhibitors of whom, only 7 (9%) patients received the target dose recommended by the clinical practice guidelines. There was no documentation in the records regarding patient counselling about medication, diet, weight, exercise or smoking. CONCLUSION: ACE inhibitors were underused in elderly patients with heart failure; also achieving the target dose was poor. This data demonstrated a very low rate of use of echocardiography in elderly patients with heart failure. Counseling appeared to be a neglectedaspect of patient care.
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