Pharmacotherapy Use in Older Patients With Heart Failure and Reduced Ejection Fraction After a Skilled Nursing Facility Stay.

ABSTRACT

BACKGROUND: Little is known about guideline-directed pharmacotherapy use in patients with heart failure and reduced ejection fraction (HFrEF) discharged to skilled nursing facilities (SNFs). This study aimed to describe the use of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARBs) and evidence-based ß-blockers (EBBBs) among older patients with HFrEF within 90 days after the SNF admission and to identify factors associated with receipt of these medications. METHODS AND RESULTS: With the use of Minimum Data Set 3.0 cross-linked with Medicare data (2011-2012), we studied 35,792 Americans aged ≥65 years with HFrEF admitted to 10,333 SNFs. The median age was 82 years, 59% were women, 81% had at least moderate physical limitations, and 39% had moderate/severe cognitive impairment. Fifty-six percent received an ACEI/ARB and 53% an EBBB; one-fourth received neither. In a multivariable log-binomial model, advanced age, severe physical limitations, and greater number of comorbid conditions not associated with heart failure were inversely associated with ACEI/ARB and EBBB receipt. CONCLUSIONS: Use of standard pharmacotherapy among patients with HFrEF after an SNF stay is higher than previously reported. In the absence of evidence demonstrating the effectiveness of ACEIs/ARBs and EBBBs in this population, whether or not improvements in prescribing are warranted remains unknown.