title: Association Between Preadmission Functional Status and Use and Effectiveness of Secondary Prevention Medications in Elderly Survivors of Acute Myocardial Infarction.
abstract: OBJECTIVE
  To determine whether function-related indicators (FRIs), derived from preadmission claims data, help explain the frequent practice of forgoing secondary prevention medications observed in Medicare.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  National Medicare data.
  
  
  METHODS
  Elderly Medicare beneficiaries discharged alive from an acute myocardial infarction (AMI) hospitalization in 2007-2008 (N = 184,156).
  
  
  METHODS
  Study outcomes were number of guideline-recommended secondary prevention medications (statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) used after discharge and 12-month survival. Preadmission data (FRIs, cardiovascular conditions, comorbid conditions), type of AMI (non-ST-elevation myocardial infarction, anterior, other), and procedures and complications during the hospitalization were from claims data.
  
  
  RESULTS
  Function-related indicators (FRIs) were common before admission; 50% of individuals had at least one (range 0-11). After discharge, 85.8% used at least one class of guideline medication, and 30.2% used all three; 19.6% died within 12 months. Each additional FRI reduced the likelihood of receiving all three medication classes by 5% (adjusted odds ratio = 0.95, 95% confidence interval (CI) = 0.94-0.96) and increased 12-month mortality by 20% (adjusted hazard ratio (aHR) = 1.20, 95% CI = 1.19-1.21). Individuals taking all three classes of medication were 30% less likely to die within 12 months than those not taking guideline medications (aHR = 0.70, 95% CI = 0.67-0.73). Similar survival benefit was observed in individuals with and without functional impairments.
  
  
  CONCLUSIONS
  Greater impairment in preadmission functional status, using a measure derived from claims data, was associated with less use of secondary prevention medications after AMI. Survival benefits of taking these medications were consistent across functional impairment levels.
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.affiliation: Schneider Research Associates, LLC, Des Moines, Iowa.|Buccaneer, A General Dynamics Company, West Des Moines, Iowa.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schneider
authors.affiliation: Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Schroeder
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Elena
authors.initials: E
authors.lastname: Letuchy
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Robinson
authors.affiliation: Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
authors.forename: John M
authors.initials: JM
authors.lastname: Brooks
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; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*; D012720:Severity of Illness Index; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: administrative claims data; disability; frailty; functional status; myocardial infarction