射血分数降低的心力衰竭患者住院后的药物治疗及其与转至长期护理机构的关联：基于中风地理和种族差异原因（REGARDS）人群的横断面分析
Medical therapy following hospitalization for heart failure with reduced ejection fraction and association with discharge to long-term care: a cross-sectional analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) population.
作者信息
Levitan Emily B, Van Dyke Melissa K, Chen Ligong, Durant Raegan W, Brown Todd M, Rhodes J David, Olubowale Olusola, Adegbala Oluwole Muyiwa, Kilgore Meredith L, Blackburn Justin, Albright Karen C, Safford Monika M
机构信息
University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, RPHB 220, Birmingham, AL, 35294-0022, USA.
出版信息
BMC Cardiovasc Disord. 2017 Sep 16;17(1):249. doi: 10.1186/s12872-017-0682-3.
BACKGROUND
Less intensive treatment for heart failure with reduced ejection fraction (HFrEF) may be appropriate for patients in long-term care settings because of limited life expectancy, frailty, comorbidities, and emphasis on quality of life.
METHODS
We compared treatment patterns between REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants discharged to long-term care versus home following HFrEF hospitalizations. We examined medical records and Medicare pharmacy claims for 147 HFrEF hospitalizations among 80 participants to obtain information about discharge disposition and medication prescriptions and fills.
RESULTS
Discharge to long-term care followed 22 of 147 HFrEF hospitalizations (15%). Participants discharged to long-term care were more likely to be prescribed beta-blockers and less likely to be prescribed aldosterone receptor antagonists and hydralazine/isosorbide dinitrate (96%, 14%, and 5%, respectively) compared to participants discharged home (81%, 22%, and 23%, respectively). The percentages of participants discharged to long-term care and home who had claims for filled prescriptions were similar for beta-blockers (68% versus 66%) and angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARBs) (45% versus 47%) after 1 year. Smaller percentages of participants discharged to long-term care had claims for filled prescriptions of other medications compared to participants discharged home (diuretics: long-term care-50%, home-72%; hydralazine/isosorbide dinitrate: long-term care-5%, home-23%; aldosterone receptor antagonists: long-term care-5%, home-23%).
CONCLUSIONS
Differences in medication prescriptions and fills among individuals with HFrEF discharged to long-term care versus home may reflect prioritization of some medical therapies over others for patients in long-term care.
背景
由于预期寿命有限、身体虚弱、合并症以及对生活质量的重视，对于射血分数降低的心力衰竭（HFrEF）患者，采用强度较低的治疗可能是合适的。
方法
我们比较了因HFrEF住院后出院至长期护理机构与出院回家的《中风地理和种族差异原因》（REGARDS）研究参与者之间的治疗模式。我们检查了80名参与者中147次HFrEF住院的病历和医疗保险药房报销记录，以获取出院处置以及药物处方和配药的信息。
结果
147次HFrEF住院中有22次（1５%）出院至长期护理机构。与出院回家的参与者相比，出院至长期护理机构的参与者更有可能被处方β受体阻滞剂，而被处方醛固酮受体拮抗剂和肼屈嗪/异山梨醇二硝酸酯的可能性较小（分别为96%、14%和5%），而出院回家的参与者相应比例分别为81%、22%和23%。1年后，出院至长期护理机构和出院回家的参与者中，β受体阻滞剂（68%对66%）以及血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（ACEI/ARBs）（45%对47%）的配药报销比例相似。与出院回家的参与者相比，出院至长期护理机构的参与者中，其他药物的配药报销比例较小（利尿剂：长期护理机构-50%，回家-72%；肼屈嗪/异山梨醇二硝酸酯：长期护理机构-5%，回家-23%；醛固酮受体拮抗剂：长期护理机构-5%，回家-23%）。
结论
HFrEF患者出院至长期护理机构与出院回家在药物处方和配药方面的差异，可能反映了长期护理患者中某些药物治疗相对于其他治疗的优先顺序。
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