Effects of Statins for Secondary Prevention on Functioning and Other Outcomes Among Nursing Home Residents |
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| Affiliation: | 1. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI;2. Department of Epidemiology, Brown University School of Public Health, Providence, RI;3. Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI;4. Department of Pharmacy, Rhode Island Hospital, Providence, RI;5. Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark;6. Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;7. Division of Cardiology, Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI;8. Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI;9. Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA;1. LeadingAge LTSS Center @UMass Boston, Washington, DC;2. Department of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY;3. School of Professional Studies, Columbia University, New York, NY |
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| Abstract: | ObjectivesStudies examining the effects of statins after acute myocardial infarction (AMI) excluded frail older adults, especially nursing home (NH) residents, and few examined functional outcomes. Older NH residents may benefit less from statins and be particularly susceptible to adverse drug events like myopathy-related functional decline. We evaluated the effects of statins on 1-year functional decline, rehospitalization, and death in NH residents.DesignWe conducted a retrospective cohort study using 2007-2010 linked national data from Minimum Data Set (MDS) assessments, Medicare claims, and Online Survey Certification and Reporting System records.Setting and ParticipantsWe included US NH residents 65 years and older who were statin nonusers, were hospitalized for AMI between May 2007 and March 2010, and returned to the NH.MeasuresOutcomes were functional decline, death, and rehospitalization in the first year after post-AMI NH admission. New statin users were 1:1 propensity-score matched to nonusers to adjust for 92 characteristics. We estimated hazard ratios (HRs) and restricted mean survival time differences with 95% confidence intervals (CIs) comparing individuals who did vs did not initiate statin therapy after AMI hospitalization.ResultsPropensity-score matching yielded a cohort of 5440 residents. Mean age was 83 years and 69% were female. Statin use was associated with a reduction in mortality (HR 0.80, 95% CI 0.73-0.87), corresponding to a mean of 15.9 (95% CI 9.9-22.0) days of extended life expectancy. No overall differences in rehospitalization (HR 1.06, 95% CI 0.98-1.14) or functional decline (HR 1.00, 95% CI 0.88-1.14) were observed.Conclusions and ImplicationsStatins may reduce 1-year mortality by 20% without affecting function among older NH residents who wish to live longer after AMI. During shared decision making with these patients or their representatives, clinicians should consider communicating that the average benefit of statins is 16 days of additional survival over 1 year. |
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| Keywords: | Hydroxymethylglutaryl-CoA reductase inhibitors frailty nursing homes secondary prevention activities of daily living |
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