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- Title
Medical therapy following hospitalization for heart failure with reduced ejection fraction and association with discharge to long-term care: a cross-sectional analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) population.
- Authors
Levitan, Emily B.; Van Dyke, Melissa K.; Ligong Chen; Durant, Raegan W.; Brown, Todd M.; Rhodes, J. David; Olubowale, Olusola; Adegbala, Oluwole Muyiwa; Kilgore, Meredith L.; Blackburn, Justin; Albright, Karen C.; Safford, Monika M.; Chen, Ligong
- Abstract
<bold>Background: </bold>Less intensive treatment for heart failure with reduced ejection fraction (HFrEF) may be appropriate for patients in long-term care settings because of limited life expectancy, frailty, comorbidities, and emphasis on quality of life.<bold>Methods: </bold>We compared treatment patterns between REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants discharged to long-term care versus home following HFrEF hospitalizations. We examined medical records and Medicare pharmacy claims for 147 HFrEF hospitalizations among 80 participants to obtain information about discharge disposition and medication prescriptions and fills.<bold>Results: </bold>Discharge to long-term care followed 22 of 147 HFrEF hospitalizations (15%). Participants discharged to long-term care were more likely to be prescribed beta-blockers and less likely to be prescribed aldosterone receptor antagonists and hydralazine/isosorbide dinitrate (96%, 14%, and 5%, respectively) compared to participants discharged home (81%, 22%, and 23%, respectively). The percentages of participants discharged to long-term care and home who had claims for filled prescriptions were similar for beta-blockers (68% versus 66%) and angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARBs) (45% versus 47%) after 1 year. Smaller percentages of participants discharged to long-term care had claims for filled prescriptions of other medications compared to participants discharged home (diuretics: long-term care-50%, home-72%; hydralazine/isosorbide dinitrate: long-term care-5%, home-23%; aldosterone receptor antagonists: long-term care-5%, home-23%).<bold>Conclusions: </bold>Differences in medication prescriptions and fills among individuals with HFrEF discharged to long-term care versus home may reflect prioritization of some medical therapies over others for patients in long-term care.
- Subjects
UNITED States; HOSPITAL care; HEART failure patients; LONG-term care facilities; RACIAL differences; CROSS-sectional method; HOSPITAL admission &; discharge; ADRENERGIC beta blockers; ACE inhibitors; ALDOSTERONE antagonists; CARDIOVASCULAR agents; ANGIOTENSIN receptors; COMBINATION drug therapy; COMPARATIVE studies; DISEASES; HEART failure; LONG-term health care; RESEARCH methodology; MEDICAL cooperation; MEDICAL prescriptions; POPULATION; PROGNOSIS; QUALITY of life; RESEARCH; RESEARCH funding; SURVIVAL; EVALUATION research; RETROSPECTIVE studies; STROKE volume (Cardiac output); THERAPEUTICS
- Publication
BMC Cardiovascular Disorders, 2017, Vol 17, p1
- ISSN
1471-2261
- Publication type
journal article
- DOI
10.1186/s12872-017-0682-3