title: Beta-Blocker Use in U.S. Nursing Home Residents After Myocardial Infarction: A National Study.
abstract: OBJECTIVE
  To evaluate how often beta-blockers were started after acute myocardial infarction (AMI) in nursing home (NH) residents who previously did not use these drugs and to evaluate which factors were associated with post-AMI use of beta-blockers.
  
  
  METHODS
  Retrospective cohort using linked national Minimum Data Set assessments; Online Survey, Certification and Reporting records; and Medicare claims.
  
  
  METHODS
  U.S. NHs.
  
  
  METHODS
  National cohort of 15,720 residents aged 65 and older who were hospitalized for AMI between May 2007 and March 2010, had not taken beta-blockers for at least 4 months before their AMI, and survived 14 days or longer after NH readmission.
  
  
  METHODS
  The outcome was beta-blocker initiation within 30 days of NH readmission.
  
  
  RESULTS
  Fifty-seven percent (n = 8,953) of residents initiated a beta-blocker after AMI. After covariate adjustment, use of beta-blockers was less in older residents (ranging from odds ratio (OR) = 0.89, 95% confidence interval (CI) = 0.79-1.00 for aged 75-84 to OR = 0.65, 95% CI = 0.54-0.79 for ≥95 vs 65-74) and less in residents with higher levels of functional impairment (dependent or totally dependent vs independent to limited assistance: OR = 0.84, 95% CI = 0.75-0.94) and medication use (≥15 vs ≤10 medications: OR = 0.89, 95% CI = 0.80-0.99). A wide variety of resident and NH characteristics were not associated with beta-blocker use, including sex, cognitive function, comorbidity burden, and NH ownership.
  
  
  CONCLUSIONS
  Almost half of older NH residents in the United States do not initiate a beta-blocker after AMI. The absence of observed factors that strongly predict beta-blocker use may indicate a lack of consensus on how to manage older NH residents, suggesting the need to develop and disseminate thoughtful practice standards.
authors.affiliation: Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.
authors.forename: Andrew R
authors.identifier: http://orcid.org/0000-0003-1673-4570
authors.initials: AR
authors.lastname: Zullo
authors.affiliation: Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.
authors.forename: Yoojin
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Daiello
authors.affiliation: Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.|Center of Innovation, Providence Veterans Affairs Medical Center, Providence, Rhode Island.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.affiliation: Division of Geriatrics, University of California, San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.|Division of Biostatistics, University of California, San Francisco, San Francisco, California.
authors.forename: W
authors.initials: W
authors.lastname: John Boscardin
authors.affiliation: Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.|Optum Epidemiology, Boston, Massachusetts.
authors.forename: David D
authors.initials: DD
authors.lastname: Dore
authors.affiliation: Division of Geriatrics, University of California, San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Miao
authors.affiliation: Division of Geriatrics, University of California, San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Kathy Z
authors.initials: KZ
authors.lastname: Fung
authors.affiliation: Division of Geriatrics, University of California, San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Kiya D R
authors.initials: KDR
authors.lastname: Komaiko
authors.affiliation: Division of Geriatrics, University of California, San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Steinman
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: beta-blockers; drug utilization; elderly; myocardial infarction; nursing homes