Underutilization of angiotensin-converting enzyme inhibitors in older patients with Q-wave anterior myocardial infarction in an academic hospital-based geriatrics practice

OBJECTIVE: To investigate the prevalence of angiotensin converting enzyme (ACE) inhibitors use in older persons without contraindications to ACE inhibitors and with prior Q-wave anterior myocardial infarction (MI), anterior MI with congestive heart failure (CHF), and with anterior MI and a left ventricular ejection fraction (LVEF) less than or equal to 40% in an academic hospital-based geriatrics practice. DESIGN: A retrospective analysis of charts from all older patients seen from January 1996 through July 1997 at an academic hospital-based geriatrics practice was performed to investigate the prevalence of ACE inhibitor use in older patients with prior Q-wave anterior MI, anterior MI with CHF, and anterior MI with LVEF less than or equal to 40% without contraindications to ACE inhibitors. SETTING: An academic hospital-based primary care geriatrics practice staffed by fellows in a geriatrics training program and full-time faculty geriatricians. PATIENTS: Ninety-six women and 65 men, mean age 82 +/- 8 years (range 65 to 96), were included in the study. MEASUREMENTS AND RESULTS: Of 161 patients with Q-wave anterior MI and no contraindications to ACE inhibitors, LVEF was measured in 58 patients (36%), 56 (35%) of whom were receiving ACE inhibitors. Of 45 patients with Q-wave anterior MI and CHF, 30 patients (67%) were receiving ACE inhibitors. Of 15 patients with Q-wave anterior MI and asymptomatic LVEF less than or equal to 40%, four patients (27%) were receiving ACE inhibitors. CONCLUSIONS: There is a marked underutilization of use of ACE inhibitors in treating older patients with Q-wave anterior MI in an academic hospital-based geriatrics practice.