Beta-Blocker Use in U.S. Nursing Home Residents After Myocardial Infarction: A National Study. - PubMed - NCBI
Beta-Blocker Use in U.S. Nursing Home Residents After Myocardial Infarction: A National Study.
Zullo AR1,
Lee Y1,
Daiello LA1,
Mor V1,2,
John Boscardin W3,4,5,
Dore DD1,6,
Miao Y3,4,
Fung KZ3,4,
Komaiko KDR3,4,
Steinman MA3,4.
Abstract
OBJECTIVES:
To evaluate how often beta-blockers were started after acute myocardial infarction (AMI) in nursing home (NH) residents who previously did not use these drugs and to evaluate which factors were associated with post-AMI use of beta-blockers. DESIGN:
Retrospective cohort using linked national Minimum Data Set assessments; Online Survey, Certification and Reporting records; and Medicare claims. SETTING:
PARTICIPANTS:
National cohort of 15,720 residents aged 65 and older who were hospitalized for AMI between May 2007 and March 2010, had not taken beta-blockers for at least 4 months before their AMI, and survived 14 days or longer after NH readmission. MEASUREMENTS:
The outcome was beta-blocker initiation within 30 days of NH readmission. RESULTS:
Fifty-seven percent (n = 8,953) of residents initiated a beta-blocker after AMI. After covariate adjustment, use of beta-blockers was less in older residents (ranging from odds ratio (OR) = 0.89, 95% confidence interval (CI) = 0.79-1.00 for aged 75-84 to OR = 0.65, 95% CI = 0.54-0.79 for ≥95 vs 65-74) and less in residents with higher levels of functional impairment (dependent or totally dependent vs independent to limited assistance: OR = 0.84, 95% CI = 0.75-0.94) and medication use (≥15 vs ≤10 medications: OR = 0.89, 95% CI = 0.80-0.99). A wide variety of resident and NH characteristics were not associated with beta-blocker use, including sex, cognitive function, comorbidity burden, and NH ownership. CONCLUSION:
Almost half of older NH residents in the United States do not initiate a beta-blocker after AMI. The absence of observed factors that strongly predict beta-blocker use may indicate a lack of consensus on how to manage older NH residents, suggesting the need to develop and disseminate thoughtful practice standards. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
KEYWORDS:
beta-blockers; drug utilization; elderly; myocardial infarction; nursing homes
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