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2 results on '"Matthew, Alcusky"'

1. To treat or not to treat: a comparative effectiveness analysis of oral anticoagulant outcomes among U.S. nursing home residents with atrial fibrillation

Author

Qiaoxi Chen, Jonggyu Baek, Robert Goldberg, Jennifer Tjia, Kate Lapane, and Matthew Alcusky

Subjects
Comparative effectiveness, Safety, Oral anticoagulants, Nursing home, Geriatrics, RC952-954.6
Abstract

Abstract Background Nursing home residents with atrial fibrillation are at high risk for ischemic stroke, but most are not treated with anticoagulants. This study compared the effectiveness and safety between oral anticoagulant (OAC) users and non-users. Methods We conducted a new-user retrospective cohort study by using Minimum Data Set 3.0 assessments linked with Medicare claims. The participants were Medicare fee-for-service beneficiaries with atrial fibrillation residing in US nursing homes between 2011 and 2016, aged ≥ 65 years. The primary outcomes were occurrence of an ischemic stroke or systemic embolism (effectiveness), occurrence of intracranial or extracranial bleeding (safety) and net clinical outcome (effectiveness or safety outcomes). Secondary outcomes included total mortality and a net clinical and mortality outcome. Cox proportional hazards and Fine and Grey models estimated multivariable adjusted hazard ratios (aHRs) and sub-distribution hazard ratios (sHRs). Results Outcome rates were low (effectiveness: OAC: 0.86; non-users: 1.73; safety: OAC: 2.26; non-users: 1.75 (per 100 person-years)). OAC use was associated with a lower rate of the effectiveness outcome (sHR: 0.69; 95% Confidence Interval (CI): 0.61–0.77), higher rates of the safety (sHR: 1.70; 95% CI: 1.58–1.84) and net clinical outcomes (sHR: 1.20; 95% CI: 1.13–1.28) lower rate of all-cause mortality outcome (sHR: 0.60; 95% CI: 0.59–0.61), and lower rate of the net clinical and mortality outcome (sHR: 0.60; 95% CI: 0.59–0.61). Warfarin users, but not DOAC users, had a higher rate of the net clinical outcome versus OAC non-users. Conclusions Our results support the benefits of treatment with OACs to prevent ischemic strokes and increase longevity, while highlighting the need to weigh apparent benefits against elevated risk for bleeding. Results were consistent with net favorability of DOACs versus warfarin.

Published
2024
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2. Reduction in unplanned hospitalizations associated with a physician focused intervention to reduce potentially inappropriate medication use among older adults: a population-based cohort study

Author

S. Del Canale, Ryan B. Thomas, N. Jafari, Matthew Alcusky, Vittorio Maio, M. Lombardi, Scott W. Keith, and A. Kee

Subjects
medicine.medical_specialty, medicine.medical_treatment, Population, Psychological intervention, Inappropriate Prescribing, lcsh:Geriatrics, 030204 cardiovascular system & hematology, Health outcomes, Cohort Studies, 03 medical and health sciences, Population based cohort, 0302 clinical medicine, Acute care, Intervention (counseling), medicine, Humans, Longitudinal Studies, 030212 general & internal medicine, education, Potentially Inappropriate Medication List, Aged, Hospitalizations, education.field_of_study, Medication use, Rehabilitation, business.industry, Hospitalization, lcsh:RC952-954.6, Prescribing, Italy, Older adults, Geriatrics and Gerontology, business, Research Article, Demography
Abstract

Background A multimodal general practitioner-focused intervention in the Local Health Authority (LHA) of Parma, Italy, substantially reduced the prevalence of potentially inappropriate medication (PIM) use among older adults. Our objective was to estimate changes in hospitalization rates associated with the Parma LHA quality improvement initiative that reduced PIM use. Methods This population-based longitudinal cohort study was conducted among older residents (> 65 years) using the Parma LHA administrative healthcare database. Crude and adjusted unplanned hospitalization rates were estimated in 3 periods (pre-intervention: 2005–2008, intervention: 2009–2010, post-intervention: 2011–2014). Multivariable negative binomial models estimated trends in quarterly hospitalization rates among individuals at risk during each period using a piecewise linear spline for time, adjusted for time-dependent and time-fixed covariates. Results The pre-intervention, intervention, and post-intervention periods included 117,061, 107,347, and 121,871 older adults and had crude hospitalization rates of 146.2 (95% CI: 142.2–150.3), 146.8 (95% CI: 143.6–150.0), and 140.8 (95% CI: 136.9–144.7) per 1000 persons per year, respectively. The adjusted pre-intervention hospitalization rate was declining by 0.7% per quarter (IRR = 0.993; 95% CI: 0.991–0.995). The hospitalization rate declined more than twice as fast during the intervention period (1.8% per quarter, IRR = 0.982; 95% CI: 0.979–0.985) and was nearly constant post-intervention (IRR: 0.999; 95% CI: 0.997–1.001). Contrasting model predictions for the intervention period (Q1 2009 to Q4 2010), the intervention was associated with 1481 avoided hospitalizations. Conclusion In a large population of older adults, a multimodal general practitioner-focused intervention to decrease PIM use was associated with a decline in the unplanned hospitalization rate. Such interventions to reduce high risk medication use among older adults warrant consideration by health systems seeking to improve health outcomes and reduce high-cost acute care utilization.

Published
2021
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