Geriatric contribution to heart failure care: a retrospective review of patient records

Abstract Background: Research on heart failure (HF) has often focused on younger patients. The aim of this study was to analyze extent of investigation and treatment changes among patients during inpatient geriatric care for worsening of HF as well as information given to next caregiver. Methods: Data were retrospectively collected from 134 individuals treated for heart failure (HF) as main diagnosis in wards specialized in geriatric medicine. Data on referral content, Natriuretic peptide type B(NT-pro-BNP), echocardiography (ECHO) and drug treatment as well as length of care episode and information to the next caregiver, were collected. Results: During the investigated geriatric care episode, 20 % of the patients were analyzed for NT-pro-BNP and 2 % were investigated with ECHO. No significant changes in drug treatment with angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) or beta blockers (BB) were made, but significant increase in treatment with furosemide (55 to 83 %, p<0.001) and spironolactone (19 to 28 %, p=0.033) was observed. Five patients were at discharge treated with target doses of both ACEI/ARB and BB. A subgroup of patients was prescribed more spironolactone during the care episode (higher dose or new prescription). These patients had more weight loss (p<0.001), longer care episodes (p=0.002) and more NT-pro-BNP assessments (p=0.008) where the longer care episode seemed to influence the increase of spironolactone most. There was a significant wash out of information in the referrals at discharge to primary care, compared to the referrals at admission to geriatric care. Information on etiology dropped from 31.4 % to 5.8 % (p<0.001) and information on ejection fraction (EF) dropped from 19.8% to 3.5% (p<0.001). Conclusions: The contribution by geriatric care to investigations was modest or low. During the geriatric care episode, no net changes in pharmacological treatments for heart failure were made, except for spironolactone and furosemide. The wash out of information about the patients in referrals from geriatricians to primary care physicians is worrying. More collaboration between cardiologists, geriatricians and primary care physicians may improve the health situation among geriatric HF patients.