Carolyn T Thorpe1,2, Florentina E Sileanu1, Maria K Mor1,3, Xinhua Zhao1, Sherrie Aspinall1,4,5, Mary Ersek6,7, Sydney Springer1,8, Joshua D Niznik1,2,9, Michelle Vu1,4, Loren J Schleiden1,5, Walid F Gellad1,10, Jacob Hunnicutt1, Joshua M Thorpe1,2, Joseph T Hanlon1,10,11. 1. Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA. 2. Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina. 3. Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. 4. VA Center for Medication Safety, Hines, Illinois. 5. University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania. 6. Veterans Experience Center and the Center for Health Equity Research and Promotion; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania. 7. School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania. 8. University of New England College of Pharmacy, Portland, Maine. 9. Division of Geriatric Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 10. Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. 11. Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND/ OBJECTIVES: Geriatric guidelines recommend against statin use in older adults with limited life expectancy (LLE) or advanced dementia (AD). This study examined resident and facility factors predicting statin discontinuation after nursing home (NH) admission in veterans with LLE/AD taking statins for secondary prevention. DESIGN: Retrospective cohort study of Veterans Affairs (VA) bar code medication administration records, Minimum Data Set (MDS) assessments, and utilization records linked to Medicare claims. SETTING: VA NHs, known as community living centers (CLCs). PARTICIPANTS: Veterans aged 65 and older with coronary artery disease, stroke, or diabetes mellitus, type II, admitted in fiscal years 2009 to 2015, who met criteria for LLE/AD on their admission MDS and received statins in the week after admission (n = 13,110). MEASUREMENTS: Residents were followed until statin discontinuation (ie, gap in statin use ≥14 days), death, or censoring due to discharge, day 91 of the stay, or end of the study period. Competing risk models assessed cumulative incidence and predictors of discontinuation, stratified by whether the resident had their end-of-life (EOL) status designated or used hospice at admission. RESULTS: Overall cumulative incidence of statin discontinuation was 31% (95% confidence interval [CI] = 30%-32%) by day 91, and it was markedly higher in those with (52%; 95% CI = 50%-55%) vs without (25%; 95% CI = 24%-26%) EOL designation/hospice. In patients with EOL designation/hospice (n = 2,374), obesity, congestive heart failure, and admission from nonhospital settings predicted decreased likelihood of discontinuation; AD, dependency in activities of daily living, greater number of medications, and geographic region predicted increased likelihood of discontinuation. In patients without EOL designation/hospice (n = 10,736), older age and several specific markers of poor prognosis predicted greater discontinuation, whereas obesity/overweight predicted decreased discontinuation. CONCLUSION: Most veterans with LLE/AD taking statins for secondary prevention do not discontinue statins following CLC admission. Designating residents as EOL status, hospice use, and individual clinical factors indicating poor prognosis may prompt deprescribing. Published 2020. This article is a U.S. Government work and is in the public domain in the USA.
BACKGROUND/ OBJECTIVES: Geriatric guidelines recommend against statin use in older adults with limited life expectancy (LLE) or advanced dementia (AD). This study examined resident and facility factors predicting statin discontinuation after nursing home (NH) admission in veterans with LLE/AD taking statins for secondary prevention. DESIGN: Retrospective cohort study of Veterans Affairs (VA) bar code medication administration records, Minimum Data Set (MDS) assessments, and utilization records linked to Medicare claims. SETTING: VA NHs, known as community living centers (CLCs). PARTICIPANTS: Veterans aged 65 and older with coronary artery disease, stroke, or diabetes mellitus, type II, admitted in fiscal years 2009 to 2015, who met criteria for LLE/AD on their admission MDS and received statins in the week after admission (n = 13,110). MEASUREMENTS: Residents were followed until statin discontinuation (ie, gap in statin use ≥14 days), death, or censoring due to discharge, day 91 of the stay, or end of the study period. Competing risk models assessed cumulative incidence and predictors of discontinuation, stratified by whether the resident had their end-of-life (EOL) status designated or used hospice at admission. RESULTS: Overall cumulative incidence of statin discontinuation was 31% (95% confidence interval [CI] = 30%-32%) by day 91, and it was markedly higher in those with (52%; 95% CI = 50%-55%) vs without (25%; 95% CI = 24%-26%) EOL designation/hospice. In patients with EOL designation/hospice (n = 2,374), obesity, congestive heart failure, and admission from nonhospital settings predicted decreased likelihood of discontinuation; AD, dependency in activities of daily living, greater number of medications, and geographic region predicted increased likelihood of discontinuation. In patients without EOL designation/hospice (n = 10,736), older age and several specific markers of poor prognosis predicted greater discontinuation, whereas obesity/overweight predicted decreased discontinuation. CONCLUSION: Most veterans with LLE/AD taking statins for secondary prevention do not discontinue statins following CLC admission. Designating residents as EOL status, hospice use, and individual clinical factors indicating poor prognosis may prompt deprescribing. Published 2020. This article is a U.S. Government work and is in the public domain in the USA.
Authors: Joshua D Niznik; Song Zhang; Maria K Mor; Xinhua Zhao; Mary Ersek; Sherrie L Aspinall; Walid F Gellad; Joshua M Thorpe; Joseph T Hanlon; Loren J Schleiden; Sydney Springer; Carolyn T Thorpe Journal: J Am Geriatr Soc Date: 2018-10-18 Impact factor: 5.562
Authors: Milly A van der Ploeg; Carmen Floriani; Wilco P Achterberg; Jonathan M K Bogaerts; Jacobijn Gussekloo; Simon P Mooijaart; Sven Streit; Rosalinde K E Poortvliet; Yvonne M Drewes Journal: J Am Geriatr Soc Date: 2019-10-30 Impact factor: 5.562
Authors: Joshua D Niznik; Xinhua Zhao; Florentina Slieanu; Maria K Mor; Sherrie L Aspinall; Walid F Gellad; Mary Ersek; Ryan P Hickson; Sydney P Springer; Loren J Schleiden; Joseph T Hanlon; Joshua M Thorpe; Carolyn T Thorpe Journal: Diabetes Care Date: 2022-07-07 Impact factor: 17.152
Authors: Antti I Peltomaa; Kirsi Talala; Kimmo Taari; Teuvo L J Tammela; Anssi Auvinen; Teemu J Murtola Journal: Cancers (Basel) Date: 2022-06-14 Impact factor: 6.575
Authors: Jennifer Tjia; Jennifer L Lund; Deborah S Mack; Attah Mbrah; Yiyang Yuan; Qiaoxi Chen; Seun Osundolire; Cara L McDermott Journal: Curr Epidemiol Rep Date: 2021-04-23