Effects of Angiotensin-Converting Enzyme Inhibitors and Digoxin on Health Outcomes of Very Old Patients With Heart Failure

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Abstract
CONGESTIVE HEART failure (CHF) represents a new epidemic in the United States.1 By current estimates, more than 5 million patients have CHF, and 400,000 new cases are diagnosed each year.2 The magnitude of the problem is large now, but it is expected to get much worse. In fact, while the proportion of older persons will continue to rise,3 the progressive decline in death rates for coronary heart and cerebrovascular diseases,4,5 as well as improvements in the ability to detect and treat hypertension,6 will increase even further the prevalence of CHF. Half of the patients diagnosed as having CHF die within 5 years, and nearly 95% of deaths occur among persons 65 years and older.7 Heart failure is the primary discharge diagnosis in approximately 1 million hospital admissions each year, of which more than 80% are in patients 65 years and older,8 making it the most common cause of hospital admission in the Medicare population.9 At least 50% of patients will experience several hospital readmissions.10 But CHF is also a major cause of disability since it limits physical function11 and significantly erodes quality of life.12