title: Prevalence and correlates of cardiovascular medication use among nursing home residents with ischemic heart disease: results from the SHELTER study.
abstract: OBJECTIVE
  Despite being the highest group of users of many medications, older individuals remain underrepresented in clinical trials. This leaves a gap in evidence to guide management of many conditions, such as ischemic heart disease (IHD), in this population. This study aimed to describe factors associated with IHD medication use among nursing home residents in 7 European countries and Israel to depict challenges facing disease management in this population.
  
  
  METHODS
  This study was a retrospective cohort analysis.
  
  
  METHODS
  The sample included 4156 nursing home residents in the SHELTER study.
  
  
  METHODS
  All residents were assessed using the interRAI Long-Term Care Facility (LTCF) instrument. Use of angiotensin-converting enzyme inhibitor (ACEi) and/or angiotensin receptor blocker (ARB), beta-blocker (BB), antiaggregants (including acetylsalicylic acid [ASA]) and statins was analyzed. Based on the use of these medications, residents were classified into groups by medication use (as nonusers, 1-2 medications, or 3-4 medications). Generalized Estimation Equation modeling was used to explore predictors of medication use from items on the LTCF instrument as well as facility questionnaire.
  
  
  RESULTS
  Of the 1050 residents with IHD, medication use was 77.7% overall, but only 16.9% were receiving 3 to 4 medications. Use of antiaggregants was highest at 51.7% and variations in medication use were observed by country (highest in France and lowest in Italy). Functional disability was the strongest predictor of medication use, reducing the likelihood of any or optimal management. Severe cognitive impairment also reduced the likelihood of optimal management, and comorbidity generally increased the likelihood of medication use. Polypharmacy reduced the likelihood of use of 3 to 4 medications for IHD.
  
  
  CONCLUSIONS
  Optimal management of IHD in nursing home residents was low and varied by country. Individual characteristics seemed to predict IHD medication use, suggesting prescribing bias and an effect of population differences from clinical trial cohorts.
authors.affiliation: Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy; School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada. Electronic address: adfoebel@uwaterloo.ca.
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Foebel
authors.affiliation: Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Liperoti
authors.affiliation: Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gambassi
authors.affiliation: Laboratory of Research in Geriatrics and Gerontology, University of Haifa, Haifa, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Gindin
authors.affiliation: Laboratory of Research in Geriatrics and Gerontology, University of Haifa, Haifa, Israel.
authors.forename: Joshua
authors.initials: J
authors.lastname: Ben Israel
authors.affiliation: Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
authors.affiliation: Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D006233:Persons with Disabilities; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004417:Dyspnea / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D017202:Myocardial Ischemia / Q000188:drug therapy*; D009735:Nursing Homes; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019338:Polypharmacy; D015995:Prevalence; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors
keywords: Ischemic heart disease; interRAI; nursing home populations; pharmacotherapy