Natali Jokanovic1,2, Hannu Kautiainen3, J Simon Bell4, Edwin C K Tan4,5,6, Kaisu H Pitkälä3. 1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia. Natali.Jokanovic@monash.edu. 2. Pharmacy Department, Alfred Hospital, Melbourne, Australia. Natali.Jokanovic@monash.edu. 3. Department of General Practice and Unit of Primary Health Care, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. 4. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia. 5. School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. 6. Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden.
Abstract
BACKGROUND: One quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time. OBJECTIVE: The aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status. METHODS: Three comparable cross-sectional audits of cardiovascular medication use among residents aged 65 years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use. RESULTS: Cardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 and 2011 in NHs and 2007 and 2011 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p < 0.001) and ALFs (p = 0.026); however, the interaction between dementia diagnosis and time was non-significant. CONCLUSIONS: The decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.
BACKGROUND: One quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time. OBJECTIVE: The aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status. METHODS: Three comparable cross-sectional audits of cardiovascular medication use among residents aged 65 years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use. RESULTS: Cardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 and 2011 in NHs and 2007 and 2011 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p < 0.001) and ALFs (p = 0.026); however, the interaction between dementia diagnosis and time was non-significant. CONCLUSIONS: The decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.
Authors: Gilles Montalescot; Udo Sechtem; Stephan Achenbach; Felicita Andreotti; Chris Arden; Andrzej Budaj; Raffaele Bugiardini; Filippo Crea; Thomas Cuisset; Carlo Di Mario; J Rafael Ferreira; Bernard J Gersh; Anselm K Gitt; Jean-Sebastien Hulot; Nikolaus Marx; Lionel H Opie; Matthias Pfisterer; Eva Prescott; Frank Ruschitzka; Manel Sabaté; Roxy Senior; David Paul Taggart; Ernst E van der Wall; Christiaan J M Vrints; Jose Luis Zamorano; Stephan Achenbach; Helmut Baumgartner; Jeroen J Bax; Héctor Bueno; Veronica Dean; Christi Deaton; Cetin Erol; Robert Fagard; Roberto Ferrari; David Hasdai; Arno W Hoes; Paulus Kirchhof; Juhani Knuuti; Philippe Kolh; Patrizio Lancellotti; Ales Linhart; Petros Nihoyannopoulos; Massimo F Piepoli; Piotr Ponikowski; Per Anton Sirnes; Juan Luis Tamargo; Michal Tendera; Adam Torbicki; William Wijns; Stephan Windecker; Juhani Knuuti; Marco Valgimigli; Héctor Bueno; Marc J Claeys; Norbert Donner-Banzhoff; Cetin Erol; Herbert Frank; Christian Funck-Brentano; Oliver Gaemperli; José R Gonzalez-Juanatey; Michalis Hamilos; David Hasdai; Steen Husted; Stefan K James; Kari Kervinen; Philippe Kolh; Steen Dalby Kristensen; Patrizio Lancellotti; Aldo Pietro Maggioni; Massimo F Piepoli; Axel R Pries; Francesco Romeo; Lars Rydén; Maarten L Simoons; Per Anton Sirnes; Ph Gabriel Steg; Adam Timmis; William Wijns; Stephan Windecker; Aylin Yildirir; Jose Luis Zamorano Journal: Eur Heart J Date: 2013-08-30 Impact factor: 29.983
Authors: Natali Jokanovic; Edwin C K Tan; Michael J Dooley; Carl M Kirkpatrick; J Simon Bell Journal: J Am Med Dir Assoc Date: 2015-04-11 Impact factor: 4.669
Authors: Michael A Campitelli; Colleen J Maxwell; Vasily Giannakeas; Chaim M Bell; Nick Daneman; Lianne Jeffs; Andrew M Morris; Peter C Austin; David B Hogan; Dennis T Ko; Kate L Lapane; Laura C Maclagan; Dallas P Seitz; Susan E Bronskill Journal: J Am Geriatr Soc Date: 2017-08-09 Impact factor: 5.562
Authors: Sarah D Berry; Murray A Mittleman; Yuqing Zhang; Daniel H Solomon; Lewis A Lipsitz; Elizabeth Mostofsky; Dana Goldense; Douglas P Kiel Journal: Pharmacoepidemiol Drug Saf Date: 2012-03-16 Impact factor: 2.890
Authors: Alireza Malek Makan; Hein van Hout; Graziano Onder; Harriet Finne-Soveri; Henriëtte van der Roest; Rob van Marum Journal: J Am Med Dir Assoc Date: 2017-09-01 Impact factor: 4.669
Authors: Nigel S Beckett; Ruth Peters; Astrid E Fletcher; Jan A Staessen; Lisheng Liu; Dan Dumitrascu; Vassil Stoyanovsky; Riitta L Antikainen; Yuri Nikitin; Craig Anderson; Alli Belhani; Françoise Forette; Chakravarthi Rajkumar; Lutgarde Thijs; Winston Banya; Christopher J Bulpitt Journal: N Engl J Med Date: 2008-03-31 Impact factor: 91.245
Authors: Caroline Laborde; Jérémy Barben; Anca-Maria Mihai; Valentine Nuss; Jérémie Vovelle; Philippe d'Athis; Pierre Jouanny; Alain Putot; Patrick Manckoundia Journal: Int J Environ Res Public Health Date: 2020-06-24 Impact factor: 3.390