Evidence map›Paper›PMID 27861719›Full record

ArticleJournal of the American Geriatrics Society2017

Beta-Blocker Use in U.S. Nursing Home Residents After Myocardial Infarction: A National Study.

Andrew R Zullo, Yoojin Lee, Lori A Daiello, Vincent Mor, W John Boscardin, David D Dore, Yinghui Miao, Kathy Z Fung, Kiya D R Komaiko, Michael A Steinman

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Geriatrics Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
5.1field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Observational
  7. Patient-Important Adverse Events of β-blockers in Frail Older Adults after Acute Myocardial Infarction.The journals of gerontology. Series A, Biological sciences and medical sciences · 2019
    Article
  8. Observational
  9. Article
  10. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 1 country.

Andrew R ZulloDepartment of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.ORCID http://orcid.org/0000-0003-1673-4570
Yoojin LeeDepartment of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.
Lori A DaielloDepartment of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.
Vincent MorDepartment of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.
W John BoscardinDivision of Geriatrics, University of California, San Francisco, San Francisco, California.
David D DoreDepartment of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island.
Yinghui MiaoDivision of Geriatrics, University of California, San Francisco, San Francisco, California.
Kathy Z FungDivision of Geriatrics, University of California, San Francisco, San Francisco, California.
Kiya D R KomaikoDivision of Geriatrics, University of California, San Francisco, San Francisco, California.
Michael A SteinmanDivision of Geriatrics, University of California, San Francisco, San Francisco, California.
San Francisco VA Medical Center · USBrown University · USNew England College of Optometry · US

Funding

VARC CoreP30AG044281 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Louise C. Walter · 2013 to 2026
$19.9M
Develop Patient Centered Outcomes Scholars for Comparative Effectiveness ResearchK12HS022998 · AHRQ · BROWN UNIVERSITY · PI TRIKALINOS, THOMAS · 2014 to 2018
$3.4M
Prescribing cascades in older adults with and without dementiaK24AG049057 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI STEINMAN, MICHAEL A. · 2015 to 2025
$1.8M
Outcomes of beta blockers after myocardial infarction in nursing home residentsR01HL111032 · NHLBI · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI STEINMAN, MICHAEL A. · 2012 to 2014
$1.7M
AHRQ HHS K12 HS022998NHLBI NIH HHS R01 HL111032NIA NIH HHS K24 AG049057NIA NIH HHS P30 AG044281
6 · The paper itself

Abstract

objectivesTo 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.

designRetrospective cohort using linked national Minimum Data Set assessments; Online Survey, Certification and Reporting records; and Medicare claims.

settingU.S. NHs.

participantsNational 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. MEASUREMENTS: The outcome was beta-blocker initiation within 30 days of NH readmission.

resultsFifty-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.

conclusionAlmost 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.

Indexed as

Adrenergic beta-AntagonistsAgedAged, 80 and overDrug UtilizationFemaleHospitalizationHumansMaleMyocardial InfarctionPractice Patterns, Physicians'Retrospective StudiesSurvival AnalysisUnited StatesAdrenergic beta-Antagonistsbeta-blockersdrug utilizationelderlymyocardial infarctionnursing homes

Identifiers

PMID27861719
PMCPMC5397324
OpenAlexW2553319853

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.