Pharmacotherapy Use in Older Patients With Heart Failure and Reduced Ejection Fraction After a Skilled Nursing Facility Stay
Department of Quantitative Health Sciences
Cardiology | Cardiovascular Diseases | Enzymes and Coenzymes | Geriatrics | Pharmaceutical Preparations | Therapeutics
BACKGROUND: Little is known about guideline-directed pharmacotherapy use in patients with heart failure and reduced ejection fraction (HFrEF) discharged to skilled nursing facilities (SNFs). This study aimed to describe the use of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARBs) and evidence-based beta-blockers (EBBBs) among older patients with HFrEF within 90 days after the SNF admission and to identify factors associated with receipt of these medications.
METHODS AND RESULTS: With the use of Minimum Data Set 3.0 cross-linked with Medicare data (2011-2012), we studied 35,792 Americans aged > /=65 years with HFrEF admitted to 10,333 SNFs. The median age was 82 years, 59% were women, 81% had at least moderate physical limitations, and 39% had moderate/severe cognitive impairment. Fifty-six percent received an ACEI/ARB and 53% an EBBB; one-fourth received neither. In a multivariable log-binomial model, advanced age, severe physical limitations, and greater number of comorbid conditions not associated with heart failure were inversely associated with ACEI/ARB and EBBB receipt.
CONCLUSIONS: Use of standard pharmacotherapy among patients with HFrEF after an SNF stay is higher than previously reported. In the absence of evidence demonstrating the effectiveness of ACEIs/ARBs and EBBBs in this population, whether or not improvements in prescribing are warranted remains unknown.
Heart failure with reduced ejection fraction, angiotensin-converting enzyme inhibitors, skilled nursing facility, β-blockers
DOI of Published Version
J Card Fail. 2017 Dec;23(12):843-851. doi: 10.1016/j.cardfail.2017.09.007. Epub 2017 Sep 20. Link to article on publisher's site
Journal of cardiac failure
Li L, Jesdale WM, Hume A, Gambassi G, Goldberg RJ, Lapane KL. (2017). Pharmacotherapy Use in Older Patients With Heart Failure and Reduced Ejection Fraction After a Skilled Nursing Facility Stay. University of Massachusetts Medical School Faculty Publications. https://doi.org/10.1016/j.cardfail.2017.09.007. Retrieved from https://escholarship.umassmed.edu/faculty_pubs/1409