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Journal of cardiac failure v.23 no.12, 2017년, pp.843 - 851   SCIE
본 등재정보는 저널의 등재정보를 참고하여 보여주는 베타서비스로 정확한 논문의 등재여부는 등재기관에 확인하시기 바랍니다.

Pharmacotherapy Use in Older Patients With Heart Failure and Reduced Ejection Fraction After a Skilled Nursing Facility Stay

Li, Lin (Reprint requests: Lin Li, MD, PhD, 368 Plantation Street, AS7-2063, Worcester, MA 01605. Tel: +508 856 8999 ) ; Jesdale, Bill M. (Fax: +508 856 8993. ) ; Hume, Anne ; Gambassi, Giovanni ; Goldberg, Robert J. ; Lapane, Kate L. ;
  • 초록  

    Abstract Background Little is known about guideline-directed pharmacotherapy use in patients with heart failure and reduced ejection fraction (HFrEF) discharged to skilled nursing facilities (SNFs). This study aimed to describe the use of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARBs) and evidence-based β-blockers (EBBBs) among older patients with HFrEF within 90 days after the SNF admission and to identify factors associated with receipt of these medications. Methods and Results With the use of Minimum Data Set 3.0 cross-linked with Medicare data (2011–2012), we studied 35,792 Americans aged ≥65 years with HFrEF admitted to 10,333 SNFs. The median age was 82 years, 59% were women, 81% had at least moderate physical limitations, and 39% had moderate/severe cognitive impairment. Fifty-six percent received an ACEI/ARB and 53% an EBBB; one-fourth received neither. In a multivariable log-binomial model, advanced age, severe physical limitations, and greater number of comorbid conditions not associated with heart failure were inversely associated with ACEI/ARB and EBBB receipt. Conclusions Use of standard pharmacotherapy among patients with HFrEF after an SNF stay is higher than previously reported. In the absence of evidence demonstrating the effectiveness of ACEIs/ARBs and EBBBs in this population, whether or not improvements in prescribing are warranted remains unknown. Highlights Three-fourths of SNF HFrEF patients used ACEIs/ARBs or evidence-based β-blockers. Advanced age was inversely associated with these treatment practices. Severe physical limitations were inversely associated with these treatment practices. Use of recommended treatments was low in HFrEF patients with multimorbidity.


  • 주제어

    Heart failure with reduced ejection fraction .   angiotensin-converting enzyme inhibitors .   β-blockers .   skilled nursing facility.  

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