Outcomes of beta blockers after myocardial infarction in nursing home residents

疗养院居民心肌梗死后β受体阻滞剂的结果

基本信息

批准号：
8706948
负责人：
MICHAEL A. STEINMAN
金额：
$ 52.69万
依托单位：
NORTHERN CALIFORNIA INSTITUTE/RES/EDU
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-22 至 2016-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8706948
关键词：
Acute Address Adrenergic beta-Antagonists Adult Adverse effects Adverse event Affect Age Cardiovascular system Caring Cessation of life Clinical Clinical assessments Communities Data Data Set Databases Development Diagnostic Services Drug Utilization Drug usage Dyspnea Elderly Elements Event Fatigue Frail Elderly Hospitalization Hospitals Individual Inpatients Lightheadedness Longevity Medicare Medicare Part A Methods Minor Modeling Myocardial Infarction Nursing Homes Observational Study Orthostasis Outcome Patients Pattern Persons Pharmaceutical Preparations Physicians Physiological Play Population Population Study Quality of life Randomized Controlled Trials Rehabilitation therapy Relative Risks Research Research Design Resources Risk Role Secondary Prevention Series Solid Statistical Methods Sum Symptoms Testing United States clinical decision-making cohort evidence base falls functional decline functional disability functional outcomes functional status improved indexing interest mortality older patient public health relevance

项目摘要

DESCRIPTION (provided by applicant): Background: The use of beta blockers for secondary prevention after myocardial infarction (heart attack) is supported by a solid evidence base for many ambulatory populations. However, virtually no data exist on outcomes of beta blockers in older nursing home patients, who may be particularly susceptible to adverse events from beta blockers and yield less benefit from these drugs. Aims: (1) To describe patterns and predictors of beta blocker use in older nursing home patients after myocardial infarction; and (2 and 3) to determine the impact of beta blockers on functional outcomes, rehospitalization, and death in this population. Methods: Using an observational study design that combines clinical and administrative data, the study population will comprise long-term residents in a large, national nursing home chain who were hospitalized for myocardial infarction between May 2007 and March 2010 and had not been using beta blockers prior to this event. Subjects will be followed for outcomes for 6 to 32 months after hospital discharge, comparing those who were and were not started on beta blockers after the index hospitalization. Data for this study will come from (1 the Minimum Data Set, a comprehensive database of standardized clinical assessment data that is completed at regular intervals by clinicians for nearly all nursing home residents in the United States; (2) claims data on inpatient diagnoses and services from Medicare Part A; and (3) drug utilization data from Medicare Part D and from a private nursing home chain (Manor Care), which captures drug use during periods where claims data from Part D are unavailable. Propensity score approaches and other causal inference methods will be employed to control for potential confounding in the relationship between beta blocker use and the outcomes of interest. Recognizing that no single approach can conclusively address all potential confounders, a series of estimates from related approaches will be used to converge on a clinically meaningful range of effect sizes. To further test and cross-validate results, the analyses will be repeated in two other cohorts. First, results will be analyzed for all Medicare patients nationwide who returned from hospital to nursing home without an intermediary period of post-acute rehabilitation (the period invisible to Medicare Part D). Second, analyses will be repeated for patients in VA nursing homes. VA data contain additional elements not available through Medicare, allowing testing of modeling assumptions and potential biases that can be used to refine analyses in the primary cohort. Relevance / public health significance: Better understanding the benefits and harms of beta blockers in frail nursing home residents after myocardial infarction will substantially improve the evidence base and help guide treatment decisions for this important population.

描述（由申请人提供）：背景：心肌梗塞（心脏病发作）后使用β受体阻滞剂用于二次预防（心脏病发作），得到许多卧床种群的坚实证据基础。但是，几乎没有关于老年疗养院患者的β受体阻滞剂的结果的数据，他们可能特别容易受到β受体阻滞剂的不良事件的影响，而从这些药物中产生的好处较少。目的：（1）描述心肌梗塞后老年疗养院患者中使用β受体阻滞剂的模式和预测因素；（2和3）确定β受体阻滞剂对该人群中功能结果，再培育化和死亡的影响。方法：使用结合临床和行政数据的观察性研究设计，该研究人群将组成长期的居民，在2007年5月至2010年3月之间因心肌梗塞住院的大型国家疗养院连锁店，并且在此事件发生之前没有使用Beta阻滞剂。分院出院后6至32个月的结果将受试者的伴随，并将指数住院后的β受体阻滞剂开始进行比较。 Data for this study will come from (1 the Minimum Data Set, a comprehensive database of standardized clinical assessment data that is completed at regular intervals by clinicians for nearly all nursing home residents in the United States; (2) claims data on inpatient diagnoses and services from Medicare Part A; and (3) drug utilization data from Medicare Part D and from a private nursing home chain (Manor Care), which captures drug use during periods where claims data from Part D不可用。将使用其他因果推理方法来控制Beta阻滞剂使用和感兴趣的结果之间的关系。首先，将为全国所有医疗保险患者分析结果，这些患者在没有中间急性康复后返回医院到疗养院（Medicare D部分看不见）。其次，将对VA疗养院中的患者重复分析。 VA数据包含通过Medicare无法获得的其他元素，从而可以测试建模假设和可用于完善主要队列分析的潜在偏差。相关性 /公共卫生的意义：更好地了解心肌梗塞后脆弱疗养院居民中β受体阻滞剂的益处和危害将大大改善证据基础，并有助于指导这一重要人群的治疗决策。