Beta‐Blocker Use in U.S. Nursing Home Residents After Myocardial Infarction: A National Study. Issue 4 (15th November 2016)

• Record Type: Journal Article
• Authors: Zullo, Andrew R.; Lee, Yoojin; Daiello, Lori A.; Mor, Vincent; John Boscardin, W.; Dore, David D.; Miao, Yinghui; Fung, Kathy Z.; Komaiko, Kiya D. R.; Steinman, Michael A.
• Is Part Of: Journal of the American Geriatrics Society. Volume 65:Issue 4(2017:Apr.)
• Page Start: 754
• Page End: 762
• Publication Date: 2016-11-15
• Subjects: nursing homes -- myocardial infarction -- beta‐blockers -- elderly -- drug utilization; Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.14671
• Languages: English
• ISSNs: 0002-8614

Abstract

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: U.S. NHs. 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.