Journal Mobile Options
Table of Contents
Vol. 103, No. 1, 2005
Issue release date: November 2004
Cardiology 2005;103:17–23

Angiotensin-Converting Enzyme Inhibitor Use in Elderly Patients Hospitalized with Heart Failure and Left Ventricular Systolic Dysfunction

Rangaswamy C. · Finn J.I. · Koelling T.M.
aUniversity of Michigan, Ann Arbor, Mich., and bUniversity HealthSystem Consortium, Oak Brook, Ill., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Purpose: Although angiotensin-converting enzyme (ACE) inhibitors are recommended for all patients with systolic heart failure, prior studies suggest that elderly cohorts are less likely to receive such therapy. The purpose of this study was to determine the age dependence of adherence to guideline-based medical care in hospitalized heart failure patients. Methods: We performed a multicenter observational cohort study including 613 patients admitted to participating hospitals with a primary diagnosis of heart failure with ejection fraction ≤40%. This cohort was divided into four age groups (group 1: <60, group 2: 60–69, group 3: 70–79, and group 4: 80 years) and adherence to guideline-based medical care was measured. Results: ACE inhibitors were administered to 83% of ideal heart failure patients, and this rate was similar for all age groups. Elderly patients received significantly lower ACE inhibitor dosages compared to their younger counterparts (168, 148, 125 and 117 mg captopril in groups 1, 2, 3, and 4, respectively, p = 0.001). Lower creatinine clearance (p < 0.001), prior residence in a long-term care facility (p = 0.037), intolerance to ACE inhibitors (p = 0.006), lower blood pressure (p = 0.005), absence of a history of hypertension (p = 0.005), and no prior heart failure hospitalizations within the past year (p = 0.001) were found to be independent predictors of low ACE inhibitor dosing. Conclusions: In this heart failure benchmarking project, elderly patients received guideline-based ACE inhibitor therapy at similar rates, but at lower doses, compared to their younger counterparts.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. The CONSENSUS Trial Study Group: Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987;316:1429–1435.
  2. The SOLVD Investigators: Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991;325:293–302.
  3. Clinical Quality Improvement Network Investigators: Mortality risk and patterns of practice in 4606 acute care patients with congestive heart failure. The relative importance of age, sex, and medical therapy. Arch Intern Med 1996;156:1669–1673.
  4. Gattis WA, Larsen RL, Hasselblad V, Bart BA, O’Connor CM: Is optimal angiotensin-converting enzyme inhibitor dosing neglected in elderly patients with heart failure? Am Heart J 1998;136:43–48.
  5. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, et al: ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: Executive summary. A report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol 2001;38:2101–2113.
  6. Stafford RS, Saglam D, Blumenthal D: National patterns of angiotensin-converting enzyme inhibitor use in congestive heart failure. Arch Intern Med 1997;157:2460–2464.
  7. Krumholz HM, Wang Y, Parent EM, Mockalis J, Petrillo M, Radford MJ: Quality of care for elderly patients hospitalized with heart failure. Arch Intern Med 1997;157:2242–2247.
  8. Nohria A, Chen YT, Morton DJ, Walsh R, Vlasses PH, Krumholz HM: Quality of care for patients hospitalized with heart failure at academic medical centers. Am Heart J 1999;137:1028–1034.
  9. Cockcroft DW, Gault MH: Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31–41.
  10. The Large State Peer Review Organization Consortium: Heart failure treatment with angiotensin-converting enzyme inhibitors in hospitalized Medicare patients in 10 large states. Arch Intern Med 1997;157:1103–1108.
  11. Drusano GL, Munice HL Jr, Hoopes JM, Damron DJ, Warren JW: Commonly used methods of estimating creatinine clearance are inadequate for elderly debilitated nursing home patients. J Am Geriatr Soc 1988;36:437–441.
  12. Lindeman RD: Changes in renal function with aging. Implications for treatment. Drugs Aging 1992;2:423–431.
  13. Williams BR, Kim J: Cardiovascular drug therapy in the elderly: Theoretical and practical considerations. Drugs Aging 2003;20:445–463.
  14. Kittleson M, Hurwitz S, Shah MR, Nohria A, Lewis E, Givertz M, et al: Development of circulatory-renal limitations to angiotensin-converting enzyme inhibitors identifies patients with severe heart failure and early mortality. J Am Coll Cardiol 2003;41:2029–2035.
  15. Ahmed A, Maisiak R, Allman RM, DeLong JF, Farmer R: Heart failure mortality among older Medicare beneficiaries: Association with left ventricular function evaluation and angiotensin-converting enzyme inhibitor use. South Med J 2003;96:124–129.
  16. Cohn J, Johnson G, Ziesche S: A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991;325:303–310.
  17. Dutka DP, Olivotto I, Ward S, Nihoyannopoulos P, al-Subaili M, Oakley CM, et al: Plasma neuro-endocrine activity in very elderly subjects and patients with and without heart failure. Eur Heart J 1995;16:1223–1230.
  18. Chen YT, Wang Y, Radford MJ, Krumholz HM: Angiotensin-converting enzyme inhibitor dosages in elderly patients with heart failure. Am Heart J 2001;141:410–417.
  19. The Network Investigators: Clinical outcome with enalapril in symptomatic chronic heart failure; a dose comparison. Eur Heart J 1998;19:481–489.
  20. Packer M, Poole-Wilson PA, Armstrong PW, Cleland JG, Horowitz JD, Massie BM, 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;100:2312–2318.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50