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Prevalence and treatment of heart failure in Swedish nursing homes
Lund University, Sweden .
Lund University, Sweden .
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
Lund University, Sweden .
2013 (English)In: BMC Geriatrics, ISSN 1471-2318, Vol. 13, no 118Article in journal (Refereed) Published
Abstract [en]

Background: Since the burden of care for elderly patients with heart failure (HF) can be decreased by therapeutic measures, it is important that such patients are identified correctly. This study explores the prevalence of HF in nursing homes in Sweden, with special consideration of the risk of failure to diagnose HF in the study population. A second aim is to explore medication and the adherence to guidelines for the treatment of HF. Methods: 429 patients from 11 nursing homes were included during 2008-2011. Information about diagnoses and medications from patient records, blood samples, questionnaire responses and blood pressure measurements were collected. The baseline characteristics of the patients, their medications and one-year mortality were identified and then compared regarding HF diagnosis and B-type natriuretic peptide (BNP) levels. A BNP level of greater than 100 ng/L was used to identify potential cases of HF. Results: The point prevalence of HF diagnosis in the medical records in the study population was 15.4%. With the recommended cut-off value for BNP, up to 196 subjects in the study population (45.7%) qualified for further screening of potential HF. The subjects in the HF and non-HF groups were similar with the exception of mean age, BNP levels and Mini Mental State Examination results which were higher in the HF group, and the eGFR and blood pressure, which were lower when HF. The subjects with higher BNP values were older and had lower eGFR, Hb, diastolic blood pressure and BMI. The subjects with HF diagnoses were in many cases not treated according to the guidelines. Loop diuretics were often used without concomitant ACE inhibitors or angiotensin receptor blockers. The subjects without HF diagnoses in the medical records at inclusion but with BNP values greater than 100 ng/L had less appropriate HF medication. The one-year mortality was 52.9% in the population with HF. Conclusions: Our study suggests that the estimated prevalence of HF in nursing homes in Sweden would increase if BNP measurements were used to select patients for further examinations. The pharmacological treatment of HF varied substantially, as did adherence to guidelines.

Place, publisher, year, edition, pages
BioMed Central , 2013. Vol. 13, no 118
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-103304DOI: 10.1186/1471-2318-13-118ISI: 000328479500001OAI: diva2:688477
Available from: 2014-01-17 Created: 2014-01-16 Last updated: 2014-01-29

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Östgren, Carl Johan
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Division of Community MedicineFaculty of Health SciencesPrimary Health Care in Motala
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