Randomized controlled intervention in cardiovascular drug treatment in nursing homes

To study drug treatment of patients with cardiovascular diseases (heart failure, post-myocardial infarction, angina pectoris, hypertonia or cardiac valvular disease) in nursing homes and assess effect of medication advice.

The patients were randomized to an intervention or control group. Medication reviews were made by one specialist in clinical pharmacology and one in cardiology. Symptoms related to heart failure or adverse reactions to cardiovascular drugs were recorded using a questionnaire. Quality of life and activities of daily living (ADL) were assessed and follow-ups performed after 2 weeks and 3 months. Outcome measures were changes of drug therapy and the global scores computed from symptoms scales.

Eighty patients were randomized. They had a mean age of 87 years and their average number of drugs was 9.6. Changed drug therapy was suggested in 40 patients and the advice was followed by the responsible physicians in 19 patients. The physicians mostly followed advice for changed furosemide therapy but not for introducing an ACE-inhibitor, probably due to uncertain diagnosis and need for follow-up after initiation of such therapy. No significant changes from baseline to later follow-up were found in the mean total scores of any questionnaire.

Intervention did not affect cardiovascular symptoms. Drug revisions should involve more than one class of drugs in order to be cost-effective.