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.

Academic Article

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.
  • Published In

    Keywords

  • Heart failure, Long-term care, Therapy, Adrenergic beta-Antagonists, Aged, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Cardiovascular Agents, Continental Population Groups, Cross-Sectional Studies, Drug Prescriptions, Drug Therapy, Combination, Female, Heart Failure, Hospitalization, Humans, Long-Term Care, Male, Mineralocorticoid Receptor Antagonists, Morbidity, Practice Patterns, Physicians', Prognosis, Quality of Life, Retrospective Studies, Stroke Volume, Survival Rate, Time Factors, United States
  • Digital Object Identifier (doi)

    Author List

  • Levitan EB; Van Dyke MK; Chen L; Durant RW; Brown TM; Rhodes JD; Olubowale O; Adegbala OM; Kilgore ML; Blackburn J
  • Start Page

  • 249
  • Volume

  • 17
  • Issue

  • 1