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

Emily B. Levitan, Melissa K. Van Dyke, Ligong Chen, Raegan W. Durant, Todd M. Brown, J. David Rhodes, Olusola Olubowale, Oluwole Muyiwa Adegbala, Meredith L. Kilgore, Justin Blackburn, Karen C. Albright, Monika M. Safford

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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. Results: 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%). Conclusions: 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.

Original languageEnglish (US)
Article number249
JournalBMC Cardiovascular Disorders
Volume17
Issue number1
DOIs
StatePublished - Sep 16 2017
Externally publishedYes

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Long-Term Care
Hospitalization
Heart Failure
Cross-Sectional Studies
Stroke
Population
Prescriptions
Therapeutics
Mineralocorticoid Receptor Antagonists
Isosorbide Dinitrate
Hydralazine
Angiotensin Receptor Antagonists
Medicare
Life Expectancy
Treatment Failure
Angiotensin-Converting Enzyme Inhibitors
Diuretics
Medical Records
Comorbidity
Quality of Life

Keywords

  • Heart failure
  • Long-term care
  • Therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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. / Levitan, Emily B.; Van Dyke, Melissa K.; Chen, Ligong; 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.

In: BMC Cardiovascular Disorders, Vol. 17, No. 1, 249, 16.09.2017.

Research output: Contribution to journalArticle

Levitan, Emily B. ; Van Dyke, Melissa K. ; Chen, Ligong ; 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. / 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. In: BMC Cardiovascular Disorders. 2017 ; Vol. 17, No. 1.
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abstract = "Background: 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. Methods: 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. Results: 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{\%}). Conclusions: 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.",
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T2 - A cross-sectional analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) population

AU - Levitan, Emily B.

AU - Van Dyke, Melissa K.

AU - Chen, Ligong

AU - Durant, Raegan W.

AU - Brown, Todd M.

AU - Rhodes, J. David

AU - Olubowale, Olusola

AU - Adegbala, Oluwole Muyiwa

AU - Kilgore, Meredith L.

AU - Blackburn, Justin

AU - Albright, Karen C.

AU - Safford, Monika M.

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AB - Background: 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. Methods: 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. Results: 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%). Conclusions: 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.

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KW - Long-term care

KW - Therapy

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