Heart disease is important in elderly patients. The treatment of myocardial infarction and heart failure are particularly important and will continue to play an important role across the globe. Advances in treatment of myocardial infarction have made tremendous inroads in the short and long term survival of patients, young and old, however, many currently employed strategies have not been tested in patients who are elderly, who paradoxically, form a growing subset of patients with heart disease. A similar paradigm exists in heart failure for both diagnosis and treatment. Attention to this issue is important when selecting treatment strategies and a focus on the goals of care is critical when decisions for care must be undertaken.
Congestive heart failure (CHF) is increasingly recognized as an important cause of morbidity and mortality. Previous studies in urban settings have shown that patients frequently are not receiving recommended therapy. There is a paucity of studies that have evaluated CHF management in a rural setting. We therefore reviewed hospital and outpatient care in this setting as an initial step toward improving CHF care.
A retrospective chart review was used to examine the care of all 34 patients hospitalized for CHF from 2000-2001 in a small rural hospital, to assess the need for improved CHF management.
The median age of the patients was 78 yr, and a number of them had many co-morbid cardiovascular risks. Similar to other studies, only 23% of patients were prescribed recommended doses of angiotensin-converting enzyme (ACE) inhibitors. Use of beta-blockers was far below expected rates. Although there was follow-up care for nearly all patients (97%), few patients had echocardiography performed (38%) or had their medications altered in the outpatient setting.
There is a need for improved management of CHF in the rural setting. Approaches to improving CHF care should use the continuity of care advantage provided by primary care physicians to optimize outpatient medical treatment regimens and improve access to diagnostic services such as echocardiography.