Association Between Preadmission Functional Status and Use and Effectiveness of Secondary Prevention Medications in Elderly Survivors of Acute Myocardial Infarction

Elizabeth A Chrischilles; Kathleen M Schneider; Mary C Schroeder; Elena Letuchy; Robert B Wallace; Jennifer G Robinson; John M Brooks

doi:10.1111/jgs.13953

Journal article

Association Between Preadmission Functional Status and Use and Effectiveness of Secondary Prevention Medications in Elderly Survivors of Acute Myocardial Infarction

Elizabeth A Chrischilles, Kathleen M Schneider, Mary C Schroeder, Elena Letuchy, Robert B Wallace, Jennifer G Robinson and John M Brooks

Journal of the American Geriatrics Society (JAGS), Vol.64(3), pp.526-535

03/2016

DOI: 10.1111/jgs.13953

PMCID: PMC8336063

PMID: 26928940

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https://www.ncbi.nlm.nih.gov/pmc/articles/8336063View

Open Access

Abstract

To determine whether function-related indicators (FRIs), derived from preadmission claims data, help explain the frequent practice of forgoing secondary prevention medications observed in Medicare. Retrospective cohort. National Medicare data. Elderly Medicare beneficiaries discharged alive from an acute myocardial infarction (AMI) hospitalization in 2007-2008 (N = 184,156). Study outcomes were number of guideline-recommended secondary prevention medications (statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) used after discharge and 12-month survival. Preadmission data (FRIs, cardiovascular conditions, comorbid conditions), type of AMI (non-ST-elevation myocardial infarction, anterior, other), and procedures and complications during the hospitalization were from claims data. Function-related indicators (FRIs) were common before admission; 50% of individuals had at least one (range 0-11). After discharge, 85.8% used at least one class of guideline medication, and 30.2% used all three; 19.6% died within 12 months. Each additional FRI reduced the likelihood of receiving all three medication classes by 5% (adjusted odds ratio = 0.95, 95% confidence interval (CI) = 0.94-0.96) and increased 12-month mortality by 20% (adjusted hazard ratio (aHR) = 1.20, 95% CI = 1.19-1.21). Individuals taking all three classes of medication were 30% less likely to die within 12 months than those not taking guideline medications (aHR = 0.70, 95% CI = 0.67-0.73). Similar survival benefit was observed in individuals with and without functional impairments. Greater impairment in preadmission functional status, using a measure derived from claims data, was associated with less use of secondary prevention medications after AMI. Survival benefits of taking these medications were consistent across functional impairment levels.

Severity of Illness Index

Myocardial Infarction - mortality

United States

Humans

Medicare - statistics & numerical data

Survivors - statistics & numerical data

Hospitalization - statistics & numerical data

Male

Secondary Prevention - methods

Angiotensin-Converting Enzyme Inhibitors - therapeutic use

Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use

Aged, 80 and over

Female

Myocardial Infarction - physiopathology

Aged

Myocardial Infarction - prevention & control

Retrospective Studies

Angiotensin Receptor Antagonists - therapeutic use

Adrenergic beta-Antagonists - therapeutic use

Details

Title: Subtitle: Association Between Preadmission Functional Status and Use and Effectiveness of Secondary Prevention Medications in Elderly Survivors of Acute Myocardial Infarction
Creators: Elizabeth A Chrischilles - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Kathleen M Schneider - Buccaneer, A General Dynamics Company, West Des Moines, Iowa
Mary C Schroeder - Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa
Elena Letuchy - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Robert B Wallace - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Jennifer G Robinson - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
John M Brooks - Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
Resource Type: Journal article
Publication Details: Journal of the American Geriatrics Society (JAGS), Vol.64(3), pp.526-535
DOI: 10.1111/jgs.13953
PMID: 26928940
PMCID: PMC8336063
NLM abbreviation: J Am Geriatr Soc
ISSN: 0002-8614
eISSN: 1532-5415
Publisher: United States
Grant note: R01 HSO18381 / PHS HHS R24HS019440 / AHRQ HHS
Language: English
Date published: 03/2016
Academic Unit: Pharmacy; Epidemiology; Pharmacy Practice and Science; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9983995044902771

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