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Background: Kaiser Permanente Southern California began offering a 4‐week supplemental benefit of home‐delivered meals to Medicare Advantage members after discharge from a hospitalization for heart failure and other medical conditions in 2021. The purpose of this study is to explore the associations between socioeconomic disadvantage and food insecurity with patient uptake of and satisfaction with the meals. Methods: Data for this cross‐sectional study were drawn from survey and electronic medical record data for members referred for the meals benefit (n = 6169) and linked to a hospitalization encounter (n = 2254) between January and December 2021. Uptake was assessed using vendor records; measures of socioeconomic status included the neighborhood deprivation index (NDI) and prior receipt of medical financial assistance (MFA) from the health system. Patients were invited to complete an email or phone survey about their satisfaction with the meals and food insecurity. Multivariable log‐binomial regression models were used to examine the association between socioeconomic disadvantage and food insecurity with meals uptake and satisfaction. Results: Sixty‐two percent of patients referred for the benefit accepted the meals (mean age: 79 ± 9, 59% people of color). While there was no significant relationship between NDI and meals uptake (RR: 0.99, 95% CI: 0.92–1.07, p = 0.77), patients who received prior MFA were more likely to accept the meals (RR: 1.09, 95% CI: 1.02–1.16, p < 0.01). Sixty‐nine percent of patients who completed the survey (23% response rate) reported that meals were very or extremely helpful. Patients with food insecurity (29% of survey respondents) were more likely to report that the meals were helpful for their recovery compared to food secure patients (RR: 1.21, 95% CI: 1.09–1.35, p < 0.01). Conclusions: The home‐delivered meals appeared to be particularly utilized by and helpful to patients with greater financial strain and/or food insecurity, suggesting that supplemental benefits could be more targeted toward addressing unmet needs of vulnerable adults. See related Editorial by Amit Kumar. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study is to determine the strength of association between treatment with triptans and acute myocardial infarction, heart failure, and death. Background: Case reports in the literature have raised concerns over an association between treatment of migraine headaches with triptans and cardiovascular events. This study aims to systematically evaluate this association in a contemporary population‐based cohort. We hypothesized that triptan exposure is not associated with increased cardiovascular events. Methods: A retrospective cohort study was conducted within an integrated healthcare delivery system in Southern California. From January 2009 to December 2018, 189,684 patients age ≥18 years had a diagnosis of migraine. In this group, 130,656 were exposed to triptans. Patients treated with triptans were matched 1:1 to those not exposed to triptans by using a propensity score. The primary outcome was acute myocardial infarction; secondary outcomes were heart failure, all‐cause death, and combined acute myocardial infarction, heart failure, and death. Results: The incidence rate of acute myocardial infarction was 0.67 per 1000 person‐year in triptan‐exposed vs 1.44 per 1000 person‐year in not exposed patients. In propensity‐matched analyses, the adjusted hazard ratio for triptan exposure was 0.95 (95% confidence interval [CI] 0.84‐1.08) for acute myocardial infarction; 1.00 (95% CI 0.93‐1.08) for all‐cause death; 0.93 (95% CI 0.81‐1.08) for heart failure; and 0.99 (95% CI 0.93‐1.06) for a composite of acute myocardial infarction, heart failure, or death. Sensitivity analyses focusing on stratified subgroups based on age, gender, ethnicity, and several cardiac risk factors also revealed no significant association between triptan exposure and cardiovascular events. Conclusions: No association was found between exposure to triptans and an increased risk of cardiovascular events. These data provide reassurance regarding the cardiovascular safety of utilizing triptans for the medical management of migraine headaches. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: The goal of this study was to describe the pattern of statin adherence in older patients, aged 80 years or older; identify factors associated with high adherence; and determine the association between statin adherence and all‐cause mortality. DESIGN: Retrospective population‐based cohort study. SETTING: An integrated healthcare system in Southern California. PARTICIPANTS: Patients hospitalized with a principal diagnosis of acute myocardial infarction (MI) between January 1, 2006, and December 31, 2016. MEASUREMENTS: Statin adherence, as measured using pharmacy dispensing records over the 365 days following hospital discharge, based on proportion of days covered (PDC). Adherence levels were categorized as high (PDC 80% or higher), partial (PDC 40% or higher and lower than 80%), and low (PDC lower than 40%). RESULTS: Between 2006 and 2016, 5629 patients, 80 years or older, hospitalized for acute MI met the inclusion criteria. Among this group, 68.8% were highly adherent to statin therapy, 20.4% were partially adherent, and 10.8% were not adherent. Male sex (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.25‐1.62) and white race (OR = 1.35; 95% CI = 1.18‐1.55) were associated with high statin adherence. Follow‐up was 4.3 ± 2.6 years. Both low and partial adherence were associated with increase mortality (low adherence: adjusted hazard radio [HR] = 1.12; 95% CI = 1.01‐1.25; partial adherence: adjusted HR = 1.22; 95% CI = 1.12‐1.32). CONCLUSIONS: In older patients, aged 80 years or older, high adherence to statins after MI was associated with improved survival. This association may not have been due only to adherence to statins but to other related factors as well. Findings from this study may inform discussions on the potential benefits of statin adherence. J Am Geriatr Soc 67:2045–2049, 2019 [ABSTRACT FROM AUTHOR]

Beta-blockers are one of the most commonly prescribed classes of antihypertensive medications during pregnancy. Previous studies reported an association between beta-blocker exposure and intrauterine growth restriction. Whether some beta-blocker subtypes may be associated with higher risk is not known. This is a retrospective cohort study of pregnant women exposed to beta-blockers in the Kaiser Permanente Southern California Region between 2003 and 2014. Logistic regression models were used to evaluate association between exposure to different beta-blocker agents and risk of low fetal birth weights. In a cohort of 379 238 singleton pregnancies, 4847 (1.3%) were exposed to beta-blockers. The four most commonly prescribed beta-blockers were labetalol (n = 3357), atenolol (n = 638), propranolol (n = 489), and metoprolol (n = 324). Mean birth weight and % low birth weight (<2500 g) were 2926 ± 841 g and 24.4% for labetalol, 3058 ± 748 g and 18.0% for atenolol, 3163 ± 702 g and 13.3% for metoprolol, 3286 ± 651 g and 7.6% for propranolol, and 3353 ± 554 g and 5.2% for non-exposed controls. Exposure to atenolol and labetalol were associated with increased risks of infant born small for gestational age (SGA) (atenolol: adjusted OR 2.4, 95% CI: 1.7-3.3; labetalol: adjusted OR 2.9, 95% CI: 2.6-3.2). Risk of SGA associated with metoprolol or propranolol exposure was not significantly different from the non-exposed group (metoprolol: adjusted OR 1.5, 95% CI: 0.9-2.3; propranolol: adjusted OR 1.3, 95% CI: 0.9-1.9). Association between beta-blocker exposure and SGA does not appear to be a class effect. Variations in pharmacodynamics and confounding by indication may explain these findings. [ABSTRACT FROM AUTHOR]

Background: Understanding family caregiver factors that influence patient outcomes could open new avenues for improving care. Our previous analysis showed lower risk of downstream patient acute care utilization among people living with dementia (PLWD) versus those without dementia following admission to home palliative care (HomePal). We aimed to examine the association between PLWD caregiver self‐rated health, preparedness, and burden with patient acute care utilization. Method: The cohort was comprised of 183 PLWD‐caregiver dyads enrolled in a trial testing two models of HomePal. We measured caregiver self‐rated health (good/very good/excellent or fair/poor), preparedness (Preparedness for Caregiving Scale, above or below the CPS median score (23), and burden (Zarit‐12, low (≤12) or high (>12) at admission. We used a proportional hazard competing risk model to assess how the risk of acute care utilization (emergency department visits, observation, and inpatient stays) was associated with baseline caregiver factors. The model was adjusted for selected patient socio‐demographics, comorbidities, hospice enrollment, and caregivers' age and relationship. Result: The PLWD cohort had a mean age of 85±8 years, were mostly female (61%) and ethnically diverse (51%, non‐White). Caregivers had a mean age of 63±12 years and were mostly female (85%), adult children (69%). Caregivers residing with PLWD (OR = 3.2, 95%CI: 1.5‐7) and Spanish speakers (OR = 3.1, 95%CI: 0.9‐10.8) were more likely to report poor/fair health. Spousal caregivers scored lower on preparedness than adult children (OR = 2.4, 95%CI: 1.2‐5). Spanish‐speakers reported less burden than English‐speakers (OR = 0.3, 95%CI: 0.1‐1.1). The median follow‐up time was 78 (IQR:171) days. In adjusted models, accounting for the competing risk of death, only caregiver low preparedness (HR = 0.63, 95%CI: 0.39‐1.02, P =.06) but not self‐rated health (HR = 0.78, 95%CI: 0.47‐1.3, P =.34) and burden (HR = 0.99, 95%CI: 0.64‐1.54, P = 0.98) was associated with lower likelihood of acute care utilization. Other PLWD or caregiver factors associated with utilization included patient older age, co‐morbidities, hospice use, and receiving care from a spouse (p<0.1). Conclusion: Caregiver factors and characteristics, in addition to patient's comorbidities, play important roles in the intensity of end‐of‐life care for PLWD. Further qualitative study is warranted to better understand the counterintuitive association between low caregiver preparedness and decreased acute care utilization. [ABSTRACT FROM AUTHOR]

This retrospective cohort study of 95 957 patients from a large integrated healthcare organization was conducted to examine whether the frequency and intervals between outpatient encounters were associated with achieving blood pressure (BP) control. Patients were followed up until they were censored or achieved BP control up to 1 year. Additionally, this study examined the time to BP control. On average, follow-up was significantly longer in patients with uncontrolled BP at 292.9 days compared with 232.2 days in those with BP control. The controlled BP group had significantly more encounters on average compared with the uncontrolled BP group (4.1 vs 3.1, standardized difference 0.33). As the number of days increased between encounters from the 1 to < 14 days, there was a consistently lower likelihood of achieving BP control. Encounter intervals of ≥180 days were associated with the lowest likelihood of achieving BP control. These findings suggest that there may be an optimal number of encounters to benefit patients with hypertension. [ABSTRACT FROM AUTHOR]

Background: There are limited data on end‐of‐life care (EOL) for decedents with dementia enrolled in Medicare Advantage plans. The purpose of this descriptive analysis is to compare socio‐demographic and clinical characteristics and patterns of healthcare utilization for decedents who were hospitalized in the last 30 days of life versus those who were not. Methods: Data were extracted from electronic health records (EHR) of individuals aged 65+ who had at least one coded ADRD diagnosis and died in 2018‐2019. Decedents with one or more hospital stays in the last 30 days of life were categorized as receiving high‐intensity EOL care (n = 6299, 45%); those with no hospitalizations were classified as receiving low‐intensity EOL care (n = 7571, 55%). We compared socio‐demographic and clinical characteristics and healthcare utilization, including life care planning (LCP) and palliative and hospice care between the two cohorts. Results: The high‐intensity cohort was minimally younger (85±7.6 vs. 86.6±7.6) and included more men (48% vs. 41%) and people of color (47% vs. 38%) compared to the low‐intensity cohort. Co‐morbidities were also higher in this group (Elixhauser: 11.5±3.6 vs. 9.9±3.7) and dementia was more often first documented in the EHR very "late" [median: 586 (IQR:85.0, 1521.0) vs. 1062 (IQR:391.0, 2012.0) days prior to death]. The high‐intensity group used more outpatient (primary care and specialty visits, 10.3 vs. 6.5), emergency visits (2.7±3.0 vs. 1.8±2.3), and inpatient (1.6±2.2 vs. 1.1±1.5) care in the prior year. Moreover, the first LCP conversation occurred much closer to death in the high‐ vs. low‐intensity group [median: 35 (IQR:10.0, 139.0) vs. 105 (IQR:45.0, 234.0) days from first conversation to death]; an advance directive or POLST were less likely to be completed (71% vs. 81%) as was receipt of home palliative care or hospice (62% vs. 82%) than in the low‐intensity cohort. All comparisons between the two cohorts were significant, p<.01. Conclusions: We found notable differences in socio‐demographic and clinical characteristics, and utilization patterns in the year prior to death between decedents with dementia who were hospitalized in the last 30 days of life vs. those who were not. Further analyses will assess key, potentially modifiable drivers of high‐intensity EOL care. [ABSTRACT FROM AUTHOR]