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Underutilization of Angiotensin‐Converting Enzyme Inhibitors in Older Patients with Q‐Wave Anterior Myocardial Infarction in an Academic Hospital‐Based Geriatrics Practice
Author(s) -
Mendelson Gad,
Aronow Wilbert S.
Publication year - 1998
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1998.tb03811.x
Subject(s) - medicine , geriatrics , heart failure , ejection fraction , myocardial infarction , ace inhibitor , angiotensin converting enzyme , cardiology , asymptomatic , blood pressure , psychiatry
OBJECTIVE: To investigate the prevalence of angiotensinconverting enzyme (ACE) inhibitors use in older persons without contraindications to ACE inhibitors and with prior Q‐wave anterior myocardial infarction (MI), anterior MI with congestive heart failure (CHF), and with anterior MI and a left ventricular ejection fraction (LVEF) ≥ 40% in an academic hospital‐based geriatrics practice. DESIGN: A retrospective analysis of charts from all older patients seen from January 1996 through July 1997 at an academic hospital‐based geriatrics practice was performed to investigate the prevalence of ACE inhibitor use in older patients with prior Q‐wave anterior MI, anterior MI with CHF, and anterior MI with LVEF ≤ 40% without contraindications to ACE inhibitors. SETTING: An academic hospital‐based primary care geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians. PATIENTS: Ninety‐six women and 65 men, mean age 82 ± 8 years (range 65 to 96), were included in the study. MEASUREMENTS AND RESULTS: Of 161 patients with Q‐wave anterior MI and no contraindications to ACE inhibitors, LVEF was measured in 58 patients (36%), 56 (35%) of whom were receiving ACE inhibitors. Of 45 patients with Q‐wave anterior MI and CHF, 30 patients (67%) were receiving ACE inhibitors. Of 15 patients with Q‐wave anterior MI and asymptomatic LVEF ≤ 40%, four patients (27%) were receiving ACE inhibitors. CONCLUSIONS: There is a marked underutilization of use of ACE inhibitors in treating older patients with Q‐wave anterior MI in an academic hospital‐based geriatrics practice.