Use of angiotensin-converting enzyme inhibitors in elderly patients with heart failure

Objective: To determine the factors associated with prescription of angiotensin-converting enzyme (ACE) inhibitors in elderly heart failure patients discharged from acute geriatric units. Design: Retrospective study of case notes. Setting: 12 acute geriatric units in the Mersey region. Subjects: 307 patients (median age 82 years; 204 women) with a discharge diagnosis of heart failure. Main outcome measures: Treatment with ACE inhibitors; use of echocardiography; presence of left ventricular systolic dysfunction on echocardiography. Results: 176 (57%) patients were discharged from hospital with an ACE inhibitor prescription; a further 19 (6%) patients had been unable to tolerate an ACE inhibitor. One hundred and twenty-one patients (39%) had undergone echocardiography. The proportion of patients in different hospitals who had echocardiography after heart failure ranged from 7 to 67%. Left ventricular systolic dysfunction was reported in 58 patients(48%); 45 of these (78%) were discharged with an ACE inhibitor prescription, seven (12%) had had a previous unsuccessful trial of ACE inhibition and two (3%) had aortic stenosis. Conclusions: The prescribing of ACE inhibitors is satisfactory in elderly heart failure patients attending acute geriatric units in this region who undergo echocardiography. However, the low use of echocardiography in some hospitals is a cause for concern.