Mortality associated with the quality of care of patients hospitalized with congestive heart failure

IntroductionHeart failure (HF) is common in older adults and standard therapy involves the use of multiple medications. We assessed the nature, frequency, and factors associated with adverse drug events (ADEs) associated with standard HF therapy among older adults greater than 75 years of age. The efficacy and predictors of ADEs were assessed in this patient population, as well.MethodsSystematic review using standardized databases including MEDLINE, Ageline, and CINAHL from January 1st 1988 to January 1st, 2010 and references from published literature. Randomized trials and studies with observational, cohort, and cross-sectional design were included. Two investigators independently selected the studies and extracted the data (kappa = 0.86).ResultsTwenty-five studies were identified. ADEs were reported in 13/23 (57%) studies. Syncope, bradycardia, and hypotension as a result of beta blockers occurred in greater frequency compared to younger populations. Spironolactone therapy resulted in increased rates of hyperkalemia, acute renal failure, and medication discontinuation. Factors associated with ADEs included advanced age, poor left ventricular function, and increasing New York Heart Association Class. Efficacy of beta blockers and ACE inhibitors appears to extend to the elderly population, but the magnitude of effect size is unclear. Very few studies reported associations between ADE and patients’ comorbidities (4/13 studies, 31%) or functional status (3/13 studies, 23%).ConclusionADEs in CHF therapy among the very elderly occurred at a greater frequency, but were generally poorly characterized in the literature despite a relatively common occurrence. Further studies are warranted.

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“…(32) performed a retrospective cohort evaluation of 621 patients with a mean age of 77.4 years. All of these patients had systolic heart failure.…”

Section: Resultsmentioning

confidence: 99%

Adverse Drug Events and Associated Factors in Heart Failure Therapy Among the Very Elderly

2011

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“…9,10 These performance measures are being used and publicly reported by governmental agencies such as the Centers for Medicare & Medicaid Services (CMS) and accreditation organizations such as JCAHO, 11 as well as major insurers, and are often the criteria of pay-forperformance demonstration projects. 12 It is therefore critical that each performance measure be currently valid and that there be a link between the processes being measured and relevant clinical outcomes.…”

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confidence: 99%

Association Between Performance Measures and Clinical Outcomes for Patients Hospitalized With Heart Failure

Fonarow¹,

Abraham²,

Albert³

et al. 2007

JAMA

461

383

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Current heart failure performance measures, aside from prescription of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge, have little relationship to patient mortality and combined mortality/rehospitalization in the first 60 to 90 days after discharge. Additional measures and better methods for identifying and validating heart failure performance measures may be needed to accurately assess and improve care of patients with heart failure.

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“…Observational studies of ACEI Table 2 shows the main characteristics of ACEI studies [15–33]. All studies but one [17] were retrospective and were conducted in clinical registries, quality performance measurement databases, or institutional clinical databases.…”

Section: Resultsmentioning

confidence: 99%

The contribution of observational studies to the knowledge of drug effectiveness in heart failure

Dobre¹,

Veldhuisen²,

DeJongste³

et al. 2007

Brit J Clinical Pharma

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Aims Randomized controlled trials (RCTs) are the golden standard for the assessment of drug efficacy. Little is known about the add‐on value of observational studies in heart failure (HF). We aimed to assess the contribution of observational studies to actual knowledge regarding the effectiveness of angiotensin‐converting enzyme inhibitors (ACEI), and β‐blockers (BB) in HF. Methods Observational studies that assessed the effectiveness of ACEI and BB in HF were identified by searching Medline, Embase, Cochrane Database (1990–2005) and the bibliographies of published articles. Cohort, case–control and time‐series analysis studies were considered for inclusion. Studies with <100 patients and those who did not perform a multivariate analysis were excluded. Results A total of 23 cohort studies met the inclusion criteria. Studies of ACEI and BB showed a decrease in mortality with drug use in elderly patients with a broad range of ejection fraction (EF), and in those with depressed EF. Additionally, they showed a decrease in mortality in patients with renal insufficiency. The effect of ACEI and BB in HF with preserved EF was not clear, although last evidence suggests a potential benefit. Low‐dose ACEI and BB may have beneficial effects. Target doses of ACEI seemed superior to low doses, but there was no clear dose–response relationship. Conclusions Observational studies in HF validate the effectiveness of ACEI and BB in populations underrepresented or excluded from RCTs. Observational studies of drug effectiveness provide relevant additional information for clinical practice.

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Mortality associated with the quality of care of patients hospitalized with congestive heart failure

Abstract: Our results show that ACEI use at discharge in elderly patients with LVSD is associated with decreased risk of death.

Cited by 23 publications

References 4 publications

Adverse Drug Events and Associated Factors in Heart Failure Therapy Among the Very Elderly

Adverse Drug Events and Associated Factors in Heart Failure Therapy Among the Very Elderly

Association Between Performance Measures and Clinical Outcomes for Patients Hospitalized With Heart Failure

The contribution of observational studies to the knowledge of drug effectiveness in heart failure

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