BACKGROUND: In 1991, SOLVD demonstrated a decrease in hospitalization and mortality rates by using angiotensin converting enzyme inhibitors (ACEI) in chronic congestive heart failure (CHF). METHODS: We conducted a study on a 10% random sample of subjects aged 65 years and older from the universal health insurance plan in Quebec. We studied all the elderly who had a dispensation of digoxin ? 0,125 mg/d and furosemide?? 40 mg/d (DF) from September 1991 to December 1994. RESULTS: Among 3,565 subjects, 61.7% used an ACEI at least once after the first dispensation of DF. Visiting a cardiologist was the strongest predictor of an ACEI dispensation (OR 1.58 95% CI 1.44-1.74). The use of ACEI remained stable from 1991 to 1994 (p = 0.92). In a subgroup of subjects free of ACEI and of any combination of digoxin/furosemide one year prior to the first DF dispensation (incident cases), 51.7% had at least one dispensation of an ACEI following the first dispensation of DF. Among these incident users of DF, 79.3% began the ACEI in the 3 months following the first dispensation of DF. CONCLUSION: In elderly taking digoxin and furosemide, the use of ACEI is widespread. Since the publication of SOLVD in 1991, there has been no change in the utilization of ACEI over time.