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 | Geriatrics
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, Lin; Jesdale, William M.; Hume, Anne; Gambassi, Giovanni; Goldberg, Robert J.; and Lapane, Kate L., "Pharmacotherapy Use in Older Patients With Heart Failure and Reduced Ejection Fraction After a Skilled Nursing Facility Stay" (2017). University of Massachusetts Medical School Faculty Publications. 1409.