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Pharmacotherapy Use in Older Patients with Heart Failure and Reduced Ejection Fraction Living in Skilled Nursing Facilities
UMass Center for Clinical and Translational Science Research Retreat
  • Lin Li, University of Massachusetts Medical School
  • William M. Jesdale, University of Massachusetts Medical School
  • Anne Hume, University of Rhode Island
  • Giovanni Gambassi, Catholic University of Sacred Heart
  • Robert J. Goldberg, University of Massachusetts Medical School
  • Kate L. Lapane, University of Massachusetts Medical School
Start Date
16-5-2017 1:45 PM
Document Type
Poster Abstract
Background: Little is known about the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and β-blockers among older adults with heart failure and reduced ejection fraction (HFrEF) in skilled nursing facilities (SNFs). Methods: Using national data Minimum Data Set 3.0 cross-linked with Medicare data (2011-2012), we studied 31,675 patients with HFrEF (ICD-9 codes: 428.2 or 428.4) aged ≥65 years admitted to 9,659 SNFs. We estimated the prevalence of a Part D claim for ACEIs/ARBs or β-blockers during 3 months before the SNF stay and used log-binomial models to evaluate correlates of use by estimating prevalence ratios (PR) and 95% confidence intervals (CI). Results: The median age of the study population was 83 years, 60% were women, and 10% and 4% were African Americans and Hispanics, respectively. Approximately 46% had ≥3 important risk factors for HFrEF. Fifty-seven percent received an ACEI/ARB and 47% a β-blocker; 25% received neither. Older age was inversely associated with receipt of these therapies: adjusted PRs were 0.94 (95% CI: 0.91-0.96) for ACEIs/ARBs and 0.86 (95% CI: 0.84-0.89) for β-blockers for patients aged ≥85 years compared with those aged 65-74 years. Compared with Whites, use of these therapies was higher among African Americans (adjusted PRs were 1.07 [95% CI: 1.04-1.10] for ACEIs/ARBs and 1.11 [95% CI: 1.08-1.15] for β-blockers) and Hispanics (adjusted PRs were 1.13 [95% CI: 1.09-1.18] for ACEIs/ARBs and 1.12 [95% CI: 1.07-1.18] for β-blockers). The prevalence of ACEI/ARB use was greater in patients with ≥3 important risk factors than in those with ≤1 factor: adjusted PR was 1.16 (95% CI 1.13-1.19). Conclusions: Use of guideline-directed medications may be suboptimal in older patients with HFrEF receiving SNF care. Whether this is a result of adverse drug events from prior use or insufficient evidence in vulnerable populations needs to be examined. Acknowledgements: Lin Li has received funding from a National Institutes of Health Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant (5T32HL120823-02)
  • pharmacotherapy,
  • angiotensin,
  • heart failure,
  • reduced ejection fracture
Creative Commons License
Creative Commons Attribution-Noncommercial-Share Alike 3.0
Citation Information
Lin Li, William M. Jesdale, Anne Hume, Giovanni Gambassi, et al.. "Pharmacotherapy Use in Older Patients with Heart Failure and Reduced Ejection Fraction Living in Skilled Nursing Facilities" (2017)
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