The benefit of angiotensin-converting enzyme (ACE) inhibitors on mortality in heart failure has been proved in randomized controlled trials.
We prospectively evaluated the prescribing of ACE inhibitors and the prescribing of target ACE inhibitor doses in 43 ambulatory patients with heart failure to identify differences in ACE inhibitor utilization among elderly and nonelderly patients. The prescribed ACE inhibitor dose and other variables were assessed by direct patient interview and information contained in the medical record. Telephone calls were conducted at 3 months to identify the occurrence of clinical events.
Fewer elderly patients were prescribed target ACE inhibitor doses compared with nonelderly patients (21.4% vs 68.8%; p = 0.0136). Elderly patients were more likely to experience an event than nonelderly patients (11 vs 4; p = 0.0074). Elderly patients not receiving target ACE inhibitor doses demonstrated a trend toward more events than elderly patients who were at target doses.
The data suggest that this group of elderly patients with heart failure who received lower ACE inhibitor doses appeared to be at higher risk for clinical events.
"Similarly, with renal dysfunction, digoxin and most angiotensin converting enzyme inhibitor (ACEI), which are eliminated through kidney, should be started at lower doses. However, elderly patients receiving ‘target’ (high) dose ACEI therapy might have better cardiac outcomes with an insignificant increase in adverse effects., These usually put clinicians in a dilemma. "
[Show abstract][Hide abstract] ABSTRACT: Chinese Herbal Medicine (CHM), as the most common form of traditional Chinese medicine (TCM), has been playing an important role in the treatment of elderly cardiovascular diseases (CVDs) in China. In this paper, we briefly discuss on the potential benefits of CHM for elderly patients with CVDs. Initially, we summarize the characteristics of CVDs in the elderly, the present treatment of CVDs in the elderly, and the clinical applications of CHM for CVDs. Secondly, in addition to introducing the features of CHM, we discuss the differences between CHM and Western medicine. Lastly, the potential benefits of CHM are presented. We came to a conclusion that as mutual complementary, Western medicine and TCM together shall benefit the elderly patients with CVDs.
"The little differences may be explained by different study populations. In consistence with our study, other researchers have also found high frequencies of inappropriate dosing     , inappropriate drugs   , need for laboratory tests  and need for additional drugs . "
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