Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 29;23(1):524.
doi: 10.1186/s12877-023-04223-3.

Use of heart failure medications in older individuals and associations with cognitive impairment

Linnea Abramsson  1 , Annica Backman  2 , Hugo Lövheim  3   4 , David Edvardsson  5 , Maria Gustafsson  6
Affiliations

Use of heart failure medications in older individuals and associations with cognitive impairment

Linnea Abramsson et al. BMC Geriatr. .

Abstract

Background: To achieve the best treatment of heart failure, it is important to use all recommended drugs at their target doses. Given that underuse of medications can occur in individuals with cognitive impairment, we investigated the filled prescriptions and target doses of heart failure medication for older individuals with and without cognitive impairment as well as associated factors.

Methods: The study was based on two separate datasets. The first dataset, which was based on data from questionnaires sent to nursing homes in Sweden, included 405 individuals with heart failure. The data were linked with the Swedish Prescribed Drug Register and the National Patient Register to obtain information regarding filled prescriptions of heart failure medications and heart failure diagnoses among the population. In the second dataset, medical records of individuals aged 75 years or older admitted to a hospital in northern Sweden were reviewed and individuals with heart failure were identified. Target doses of heart failure medications were evaluated in 66 individuals who lived at home.

Results: Filled prescriptions of mineralocorticoid receptor antagonists and loop diuretics were significantly more common in individuals without cognitive impairment (OR 1.087; 95% CI 1.026-1.152, p < 0.05) and (OR 1.057; 95% CI 1.017-1.098, p < 0.05), respectively. There were no significant differences between individuals with and without cognitive impairment in terms of achieving target doses for any of the drug classes. A higher age was associated with fewer filled prescriptions and less ability to reach the target doses of beta blockers (OR 0.950; 95% CI 0.918-0.984, p < 0.05) and (OR 0.781; 95% CI 0.645-0.946, p < 0.05), respectively.

Conclusions: Our results suggest that individuals with cognitive impairment are partly undertreated for heart failure in that they had fewer filled prescriptions of important heart medications. Separately, the relatively low proportion of older individuals reaching target doses is an important observation and indicates that treatment of heart failure could be further optimised among older individuals.

Keywords: Cognitive impairment; Filled prescriptions; Heart failure; Target doses.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare that are relevant to the content of this article.

References

    1. McDonagh TA, Metra M, Adamo M, ESC Scientific Document Group., 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC, European Heart Journal, 2021;42(36):3599–3726. 10.1093/eurheartj/ehab368.
    1. Ponikowski P, Voors AA, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the heart failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18:891–975. doi: 10.1002/ejhf.592. - DOI - PubMed
    1. Swedberg K, Kjekshus J. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) Am J Cardiol. 1988;62(2):60A–6. doi: 10.1016/s0002-9149(88)80087-0. - DOI - PubMed
    1. Packer M, Poole-Wilson PA, Armstrong PW, et al. Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group Circulation. 1999;100:23122318. - PubMed
    1. Packer M, Coats AJ, Fowler MB, et al. Carvedilol prospective randomized cumulative survival Study Group. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med. 2001;344:1651–8. doi: 10.1056/NEJM200105313442201. - DOI - PubMed

Publication types