One and one-half million older Americans live in nursing homes, and more than 50 percent of nursing home residents have cardiac disease. According to the 2013 American College of Cardiology Foundation/American Heart Association guidelines, oral beta-blocker therapy should be initiated for all individuals within 24 hours after Acute Myocardial Infarction (AMI) and continued for at least 3 years, in the absence of contraindications. Data from community-dwelling older adults have shown that use of beta-blockers after AMI decreases with increasing age, and have presented conflicting data on whether functional limitations and geriatric syndromes are associated with even lower rates of beta-blocker use. However, much less is known about the use of these agents in nursing homes, who often have different clinical characteristics and systems of care than their community-dwelling counterparts.
[Photo: Dr. Andrew Zullo]
The objective of this study, led by Dr. Andrew Zullo, Investigator in the Department of Health Services, Policy and Practice, was to describe the epidemiology of beta-blocker use after AMI in a national sample of U.S. nursing homes. The study cohort was made up of 15,729 residents aged 65 years and older who were hospitalized for AMI between 2007 and 2010.
The researchers found that only 57 percent of residents initiated beta-blocker use after AMI. The use of beta-blockers was found to be less in older residents and those with higher levels of functional impairment and medication use. Sex, cognitive function, comorbidity burden, and nursing home ownership were not associated with beta-blocker use.
The results of this study suggest that almost half of older nursing home residents in the United States do not initiate a beta-blocker after AMI. Although some factors were associated with use, the absence of factors that strongly predict beta-blocker use may indicate a lack of consensus on how to manage older nursing home residents, suggesting the need to develop and disseminate thoughtful practice standards.
This study was published in Journal of the American Geriatrics Society (ahead of print).
For more information: https://www.ncbi.nlm.nih.gov/pubmed/27861719