From the Guidelines
Cardiovascular conditions in nursing homes are a significant concern, and managing them effectively is crucial to reduce morbidity, mortality, and improve quality of life, with a focus on controlling hypertension, managing heart failure, and preventing thrombotic events, as emphasized in the most recent study by the European Society of Cardiology working group on cardiovascular pharmacotherapy 1.
Key Considerations
- The prevalence of polypharmacy is high in nursing home residents, with up to 91% taking more than 5 medications, which can lead to adverse drug reactions and interactions 1.
- Ageing-associated physiological changes can affect the pharmacodynamics of cardiovascular drugs, making it essential to carefully select and monitor medications 1.
- A comprehensive approach to management and prevention should include controlling hypertension, managing heart failure, and preventing thrombotic events.
Management Strategies
- For hypertension, start with ACE inhibitors like lisinopril (10-40 mg daily) or ARBs such as losartan (25-100 mg daily), and consider beta-blockers like metoprolol (25-200 mg daily) for residents with a history of coronary artery disease.
- For heart failure, combine these medications with careful fluid management and low-dose diuretics like furosemide (20-80 mg daily).
- To prevent thrombotic events, consider low-dose aspirin (81 mg daily) for most residents, unless contraindicated, and anticoagulation with apixaban (2.5-5 mg twice daily) or warfarin (dose adjusted to INR 2-3) for those with atrial fibrillation.
Additional Recommendations
- Implement a structured exercise program tailored to residents' abilities, such as chair exercises or supervised walking sessions for 20-30 minutes daily.
- Ensure a heart-healthy diet low in sodium and saturated fats.
- Regular monitoring of blood pressure, heart rate, and weight is crucial.
- Educate staff on recognizing early signs of cardiovascular distress, such as increased shortness of breath or sudden weight gain.
- Encourage medication adherence and implement strategies to reduce polypharmacy, as suggested by the American Heart Association and the Heart Failure Society of America 1.
From the Research
Cardiovascular Conditions in Nursing Homes
The following cardiovascular conditions are prevalent in nursing homes:
- Heart failure (HF) affects 20% of nursing home residents, causing high morbidity and mortality 2
- Cardiac vulnerability, including angina, myocardial infarction (MI), and cardiogenic shock 3
- Coronary artery disease (CAD) is a major cause of mortality in patients all around the globe 4
- Chronic heart failure (HF) is highly prevalent in nursing home residents, but treatment often does not follow guidelines 5
Treatment and Management
Treatment and management of cardiovascular conditions in nursing homes include:
- Pharmacological treatment, such as ACE-inhibitors, β-blockers, and diuretics 5
- Non-pharmacological interventions, such as lifestyle modifications and education 4
- Nurse-led interventions, including supportive, educational, preventive measures, and psychological support 4
- First-line antihypertensive medications, such as renin-angiotensin-aldosterone converting enzyme inhibitors (RAASi), amlodipine, or thiazide diuretics 6
Challenges and Concerns
Challenges and concerns in managing cardiovascular conditions in nursing homes include:
- Limited physician involvement and resident/family education 2
- Concerns about feasibility, sustainability, and quality assurance of interventions 2
- Limited use of non-pharmacological interventions 5
- Discrepancies between prescribed medication dosages and recommended guidelines 5
- Fall risk and cardiovascular outcomes associated with first-line antihypertensive medications 6