患有绝症的长期住院养老院居民中普遍使用他汀类药物。
Prevalent Statin Use in Long-Stay Nursing Home Residents with Life-Limiting Illness.
机构信息
Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
出版信息
J Am Geriatr Soc. 2020 Apr;68(4):708-716. doi: 10.1111/jgs.16336. Epub 2020 Feb 14.
OBJECTIVES
To evaluate the prevalence and factors associated with statin pharmacotherapy in long-stay nursing home residents with life-limiting illness.
DESIGN
Cross-sectional.
SETTING
US Medicare- and Medicaid-certified nursing home facilities.
PARTICIPANTS
Long-stay nursing home resident Medicare fee-for-service beneficiaries aged 65 years or older with life-limiting illness (n = 424 212).
MEASUREMENTS
Prevalent statin use was estimated as any low-moderate intensity (daily dose low-density lipoprotein-cholesterol [LDL-C] reduction <30%-50%) and high-intensity (daily dose LDL-C reduction >50%) use via Medicare Part D claims for a prescription supply on September 30, 2016, with a 90-day look-back period. Life-limiting illness was operationally defined to capture those near the end of life using evidence-based criteria to identify progressive terminal conditions or limited prognoses (<6 mo). Poisson models provided estimates of adjusted prevalence ratios and 95% confidence intervals for resident factors.
RESULTS
A total of 34% of residents with life-limiting illness were prescribed statins (65-75 y = 44.0%, high intensity = 11.1%; >75 y = 31.1%, high intensity = 5.4%). Prevalence of statins varied by life-limiting illness definition. Of those with a prognosis of less than 6 months, 23% of the 65 to 75 and 12% of the older than 75 age groups were on statins. Factors positively associated with statin use included minority race or ethnicity, use of more than five concurrent medications, and atherosclerotic cardiovascular disease or risk factors.
CONCLUSION
Despite having a life-limiting illness, more than one-third of clinically compromised long-stay nursing home residents remain on statins. Although recent national guidelines have expanded indications for statins, the benefit of continued therapy in an advanced age population near the end of life is questionable. Efforts to deprescribe statins in the nursing home setting may be warranted. J Am Geriatr Soc 68:708-716, 2020.
目的
评估患有生命终末期疾病的长期居住在养老院的居民接受他汀类药物治疗的患病率和相关因素。
设计
横断面研究。
设置
美国医疗保险和医疗补助认证的养老院设施。
参与者
长期居住在养老院的医疗保险费用报销服务的 65 岁或以上的生命终末期疾病（n=424212）居民。
测量
通过 Medicare Part D 索赔来估计他汀类药物的普遍使用情况，在 2016 年 9 月 30 日，对于处方药供应的低-中强度（每日剂量低密度脂蛋白胆固醇 [LDL-C]降低 <30%-50%）和高强度（每日剂量 LDL-C 降低 >50%）使用情况进行估计，并进行 90 天的回顾期。生命终末期疾病的操作性定义是使用基于证据的标准来捕捉那些接近生命终点的患者，以识别进行性终末期疾病或有限的预后（<6 个月）。泊松模型提供了居民因素的调整后患病率比和 95%置信区间的估计值。
结果
共有 34%患有生命终末期疾病的居民被开具了他汀类药物处方（65-75 岁=44.0%，高强度=11.1%；>75 岁=31.1%，高强度=5.4%）。他汀类药物的使用情况因生命终末期疾病的定义而有所不同。在那些预期寿命不足 6 个月的患者中，65 至 75 岁年龄组中有 23%和 75 岁以上年龄组中有 12%使用了他汀类药物。与他汀类药物使用相关的因素包括少数民族或种族、使用超过五种同时使用的药物、动脉粥样硬化性心血管疾病或风险因素。
结论
尽管患有生命终末期疾病，但超过三分之一的患有严重疾病的长期居住在养老院的居民仍在服用他汀类药物。尽管最近的国家指南扩大了他汀类药物的适应证，但在生命终末期的高龄人群中继续治疗的益处值得怀疑。在养老院环境中减少他汀类药物的使用可能是合理的。
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