Medical therapy following hospitalization for heart failure with reduced ejection fraction and association with discharge to long-term care: a cross-sectional analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) population

Emily B Levitan,Karen C Albright,Ligong Chen,Justin Blackburn,Olusola Olubowale,Melissa K Van Dyke,Oluwole Muyiwa Adegbala,Raegan W Durant,Monika M Safford,J David Rhodes,Meredith L Kilgore,Todd M Brown

doi:10.1186/s12872-017-0682-3

Abstract

BackgroundLess intensive treatment for heart failure with reduced ejection fraction (HFrEF) may be appropriate for patients in long-term care settings because of limited life expectancy, frailty, comorbidities, and emphasis on quality of life.MethodsWe compared treatment patterns between REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants discharged to long-term care versus home following HFrEF hospitalizations. We examined medical records and Medicare pharmacy claims for 147 HFrEF hospitalizations among 80 participants to obtain information about discharge disposition and medication prescriptions and fills.ResultsDischarge to long-term care followed 22 of 147 HFrEF hospitalizations (15%). Participants discharged to long-term care were more likely to be prescribed beta-blockers and less likely to be prescribed aldosterone receptor antagonists and hydralazine/isosorbide dinitrate (96%, 14%, and 5%, respectively) compared to participants discharged home (81%, 22%, and 23%, respectively). The percentages of participants discharged to long-term care and home who had claims for filled prescriptions were similar for beta-blockers (68% versus 66%) and angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARBs) (45% versus 47%) after 1 year. Smaller percentages of participants discharged to long-term care had claims for filled prescriptions of other medications compared to participants discharged home (diuretics: long-term care-50%, home-72%; hydralazine/isosorbide dinitrate: long-term care-5%, home-23%; aldosterone receptor antagonists: long-term care-5%, home-23%).ConclusionsDifferences in medication prescriptions and fills among individuals with HFrEF discharged to long-term care versus home may reflect prioritization of some medical therapies over others for patients in long-term care.

Highlights

Less intensive treatment for heart failure with reduced ejection fraction (HFrEF) may be appropriate for patients in long-term care settings because of limited life expectancy, frailty, comorbidities, and emphasis on quality of life
We examined medication treatment patterns among black and white participants of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who experienced HFrEF hospitalizations and compared treatment patterns between participants discharged to long-term care and those discharged home
REGARDS participants were discharged to long-term care following 22 of 147 HFrEF hospitalizations (15%)

Summary

Introduction

Less intensive treatment for heart failure with reduced ejection fraction (HFrEF) may be appropriate for patients in long-term care settings because of limited life expectancy, frailty, comorbidities, and emphasis on quality of life. None of the trials included patients in long-term care, and these patients may be more susceptible to side effects and have limited life expectancy [4]. These characteristics suggest that less aggressive treatment for HFrEF could be appropriate for many patients discharged to long-term care. We examined medication treatment patterns among black and white participants of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who experienced HFrEF hospitalizations and compared treatment patterns between participants discharged to long-term care and those discharged home

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Results

Discussion

Conclusion