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Beta-Blocker Use in U.S. Nursing Home Residents After Myocardial Infarction: A National Study
- Source :
- Journal of the American Geriatrics Society. 65:754-762
- Publication Year :
- 2016
- Publisher :
- Wiley, 2016.
-
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.
- Subjects :
- Male
Gerontology
medicine.medical_specialty
medicine.drug_class
Adrenergic beta-Antagonists
Myocardial Infarction
030204 cardiovascular system & hematology
Article
03 medical and health sciences
0302 clinical medicine
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Practice Patterns, Physicians'
Beta blocker
Aged
Retrospective Studies
Aged, 80 and over
Minimum Data Set
business.industry
Retrospective cohort study
Odds ratio
medicine.disease
Survival Analysis
Comorbidity
Drug Utilization
United States
Confidence interval
Hospitalization
Emergency medicine
Female
Geriatrics and Gerontology
Nursing homes
business
Subjects
Details
- ISSN :
- 00028614
- Volume :
- 65
- Database :
- OpenAIRE
- Journal :
- Journal of the American Geriatrics Society
- Accession number :
- edsair.doi.dedup.....c41bd9e8809ca16a73e9aaff2bfacd0c