Evidence map›Paper›PMID 29044457›Full record

ArticleJournal of the American Geriatrics Society2017

Secondary Prevention Medication Use After Myocardial Infarction in U.S. Nursing Home Residents.

Andrew R Zullo, Sadia Sharmin, Yoojin Lee, Lori A Daiello, Nishant R Shah, W John Boscardin, David D Dore, Sei J Lee, 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 18 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 2 pooled it
1.5field-weighted citation impact, top 19% 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

18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 24 citations in OpenAlex.

  1. Pooled it
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  14. 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
  15. Article
  16. Observational
  17. Observational
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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

9 authors at 3 institutions in 1 country.

Andrew R ZulloDepartment of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island.ORCID http://orcid.org/0000-0003-1673-4570
Sadia SharminDepartment of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Yoojin LeeDepartment of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Lori A DaielloDepartment of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Nishant R ShahDepartment of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
W John BoscardinDivision of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California.
David D DoreDepartment of Health Services, Policy, and Practice, School of Public Health, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Sei J LeeDivision of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California.
Michael A SteinmanDivision of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California.
Brown University · USSan Francisco VA Medical Center · 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

BACKGROUND/

objectivesSecondary prevention medications are recommended for older adults after acute myocardial infarction (AMI), but little is known about whether nursing home (NH) residents receive these medications. The objective was to evaluate new use of secondary prevention medications after AMI in NH residents who were previously nonusers and to evaluate what factors were associated with use.

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

settingU.S. NHs.

participantsNational cohort of 11,192 NH residents aged 65 and older who were hospitalized for an AMI between May 2007 and March 2010, had no beta-blocker or statin use for 4 months or longer before the hospitalization, and survived 14 days or more after NH readmission. MEASUREMENTS: The outcome was the number of secondary prevention medications initiated within 30 days of NH readmission.

resultsThirty-seven percent of residents had no secondary prevention medications initiated after AMI, 41% had 1 initiated, and 22% had 2 initiated. After covariate adjustment, fewer secondary prevention medications were used in older residents (proportional odds ratio (POR) = 0.48, 95% confidence interval (CI)  = 0.40-0.57 for ≥95 vs 65-74); women (POR = 0.88, 95% CI = 0.80-0.96);and those with a do-not-resuscitate (DNR) order (POR = 0.90, 95% CI = 0.83-0.98), functional impairment (dependent or totally dependent vs independent to limited assistance, POR = 0.77, 95% CI = 0.69-0.86), and cognitive impairment (moderate to severe vs no impairment, POR = 0.79, 95% CI = 0.70-0.89).

conclusionMore than one-third of older NH residents in the United States do not have any secondary prevention medications initiated after AMI, with fewer medications initiated in older residents; women; and those with, DNR orders, poor physical function, and cognitive impairment. A lack of evidence about the safety and effectiveness of secondary preventions medications in the NH population and unmeasured person-centered goals of care are plausible explanations for these findings.

Indexed as

Nursing HomesSeverity of Illness IndexAdrenergic beta-AntagonistsAgedAged, 80 and overCohort StudiesDisease ProgressionFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMyocardial InfarctionSecondary PreventionSurvival AnalysisSurvivorsUnited StatesAdrenergic beta-AntagonistsHydroxymethylglutaryl-CoA Reductase Inhibitorsantiplateletsbeta-blockersmyocardial infarctionnursing homestatins

Identifiers

PMID29044457
PMCPMC5683399
OpenAlexW2765211334

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.