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Southern Medical Journal:
Original Articles

Heart Failure Mortality among Older Medicare Beneficiaries: Association with Left Ventricular Function Evaluation and Angiotensin-converting Enzyme Inhibitor Use

Ahmed, Ali MD, MPH, FACP; Maisiak, Richard PHD; Allman, Richard M. MD; DeLong, James F. MD, FACP; Farmer, Robert

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Abstract

Background: Left ventricular function evaluation and angiotensin-converting enzyme (ACE) inhibitor use are the two basic indicators of heart failure quality of care. In this retrospective follow-up study, we analyzed the association between these two quality indicators and mortality in elderly hospitalized heart failure patients.

Methods: The patients in our study were older Alabama Medicare beneficiaries discharged with a diagnosis of heart failure in 1994. Cox regression analyses, adjusted for various patient and care characteristics, were performed to estimate the overall mortality rate.

Results: The mean age of the 1,090 patients in our study was 79 ± 7.5 years. Both left ventricular function evaluation (hazard ratio, 0.83; 95% confidence interval, 0.705–0.976) and ACE inhibitor use (hazard ratio, 0.77; 95% confidence interval, 0.655–0.905) were associated with a lower 3-year mortality rate. Adjustment for various patient and care characteristics did not alter these associations.

Conclusion: Left ventricular function evaluation and ACE inhibitor use were each associated with increased survival time in older Medicare beneficiaries with heart failure.

Key Points

* Left ventricular function evaluation and angiotensin-converting enzyme inhibitor use, the 2 key quality indicators of heart failure care, are often underutilized.

* Randomized, controlled trials of angiotensin-converting enzyme inhibitors often excluded older patients, and were restricted to those with systolic dysfunction and without contraindications to the angiotensin-converting enzyme inhibitor.

* Of 1,090 older Alabama Medicare beneficiaries discharged with a diagnosis of heart failure, 732 (67%) died within 3 years of discharge.

* Patients receiving left ventricular function evaluation had a risk reduction of 24% in 3-year risk-adjusted mortality rate, and those taking angiotensin-converting enzyme inhibitors at discharge had a 19% risk reduction.

* Heart failure remains a disease with a poor prognosis that can be favorably altered by following recommended management guidelines.

© 2003 Southern Medical Association

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