Age-related differences in management of heart disease: a study of cardiac medication use in an older cohort. Pacemaker Selection in the Elderly (PASE) Investigators

J Am Geriatr Soc. 1999 Feb;47(2):145-50. doi: 10.1111/j.1532-5415.1999.tb04571.x.


Background: Previous studies have suggested suboptimal use of cardiac medications for secondary prevention after myocardial infarction (MI) and atrial fibrillation (AF), especially among older people.

Objective: To determine whether patients older than 75 years are less likely than those aged 65 to 74 to be prescribed medications with evidence-based indications, including angiotensin-converting enzyme (ACE) inhibitors for left ventricular dysfunction (LVD) and/or diabetes mellitus (DM), aspirin and/or beta-blockers for those with a history of MI, and warfarin for chronic AF.

Design: A retrospective cohort study.

Setting: Twenty-nine hospitals, predominantly tertiary-care institutions.

Participants: A total of 407 patients randomized to ventricular or dual-chamber pacing from February 26, 1993, to September 30, 1994, in the Pacemaker Selection in the Elderly (PASE) trial.

Measurements: A review of the patient's medical history and a physical exam at study enrollment, three follow-up timepoints, and a study closeout.

Results: Patients older than 75 years with LVD and/or DM were less likely to be prescribed ACE inhibitors (OR = .56 (0.31-1.00)); patients older than 75 with a history of MI were less likely to be taking aspirin (OR = .43 (0.19-.95)), and patients older than 75 with AF were less likely to be prescribed warfarin (OR = .18 (0.05-.61)). Patients older than 75 years of age with any or all of the conditions studied were less likely to be prescribed indicated medications than those ages 65 to 74 (OR = .35 (0.18-.70)), after controlling for between-group differences in comorbidity, gender, and number of noncardiac medications.

Conclusion: Older age is a significant independent negative correlate of evidence-based cardiac medication use in this cohort. Causes for this finding need to be explored.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / drug therapy*
  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / therapeutic use*
  • Combined Modality Therapy
  • Comorbidity
  • Diabetes Mellitus / drug therapy
  • Drug Therapy, Combination
  • Drug Utilization
  • Female
  • Frail Elderly*
  • Humans
  • Male
  • Myocardial Infarction / drug therapy*
  • Pacemaker, Artificial
  • Retrospective Studies
  • Single-Blind Method
  • Ventricular Dysfunction, Left / drug therapy


  • Cardiovascular Agents