Seguimiento de guías farmacoterapéuticas en mayores de 85 años con insuficiencia cardiaca estadio C. Efecto sobre la mortalidad al año

Abstract

Objective To describe factors related to prescription on discharge of treatment for Chronic Heart Failure(CHF)-Stage C and to analyse whether this is related to 12month-mortality. Material and methods Observational follow-up study of patients over 85 hospitalized during 2006/7 with Stage C-Chronic Heart Failure in an outskirt support hospital. Drug-prescription adherence was assessed according to the American Heart Society 2005-Guidelines and recommendations of the American Geriatrics Society-2007. A multivariate analysis of logistic regression was performed to obtain odds for 12-month mortality for each recommended therapy, adjusting by mortality risk factors. Results 104 patients aged 90±3 yr were followed on discharge, 85% of which were women. NYHA-classes were distributed NYHA I-28,2%, II-37,9%, III-30,1%, IV-3,9%. Most frequently prescribed drugs were loop diuretics (83,3%) and IACEs/ARB (62%), and the less frequent beta-blockers (19,1%). IACEs/ARB were prescribed to those with lower functional impairment (p=0.04), and beta-blockers to those with worse NYHA class (p=0.02). All recommended prescriptions had a tendency to 12 month mortality risk reduction, even adjusted by age, functional status, co-morbidity, NYHA class and co-morbid atrial fibrillation, except for spironolactone (OR-1,8; IC95% 0,48–17,19). Conclusions Treatment with CHF disease-modifying therapies except for spironolactone can reduce 12 month risk mortality, also in the oldest old. There exists room for improvement in frequency of drug prescription in this group of age.