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

Linnea Abramsson1, Annica Backman2, Hugo Lövheim3,4

  • 1Department of Integrative Medical Biology, Umeå University, Umeå, 901 87, Sweden.

BMC Geriatrics
|August 29, 2023
PubMed

Insights

Older adults with cognitive impairment receive fewer heart failure prescriptions. Achieving target medication doses remains a challenge for many older individuals, indicating a need for optimized heart failure treatment.

Area of Science:

  • Gerontology
  • Cardiology
  • Pharmacology

Background:

  • Optimal heart failure treatment requires adherence to recommended drug regimens at target doses.
  • Cognitive impairment can lead to underuse of essential medications.
  • Investigating medication use in older adults with and without cognitive impairment is crucial for understanding treatment gaps.

Purpose of the Study:

  • To compare filled prescriptions and target doses of heart failure medications in older individuals with and without cognitive impairment.
  • To identify factors associated with medication underuse and suboptimal dosing in this population.

Main Methods:

  • Utilized two Swedish datasets: nursing home residents linked to national registers and medical records of older hospital patients.
  • Analyzed filled prescriptions for mineralocorticoid receptor antagonists, loop diuretics, and beta blockers.
  • Evaluated achievement of target doses for heart failure medications in home-dwelling individuals aged 75+.

Main Results:

  • Individuals without cognitive impairment had significantly more filled prescriptions for mineralocorticoid receptor antagonists and loop diuretics.
  • No significant differences were found in achieving target doses between cognitively impaired and non-impaired groups.
  • Advanced age correlated with fewer filled prescriptions and lower achievement of target doses for beta blockers.

Conclusions:

  • Cognitive impairment is associated with undertreatment of heart failure due to fewer filled prescriptions for key medications.
  • A substantial proportion of older adults do not reach target medication doses, highlighting opportunities for optimizing heart failure management.
Abstract

Keywords:
Cognitive impairmentFilled prescriptionsHeart failureTarget doses

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