Geographic Variation in Anticoagulant Use and Resident, Nursing Home, and County Characteristics Associated With Treatment Among US Nursing Home Residents

Alcusky, Matthew; Baek, Jonggyu; Tjia, Jennifer; McManus, David D.; Lapane, Kate L.

doi:10.1016/j.jamda.2020.10.001

Cited by 4 publications

(4 citation statements)

References 46 publications

(38 reference statements)

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“…Prior studies highlight the increasing prevalence of OAC use among older adults and nursing home patients. 9,23,24 Our study affirms these observations, finding that OAC use was more likely among EMS responses at nursing, rehabilitation and long-term care facilities. Our study spotlights the broader systemwide prevalence of OAC use.…”

Section: Discussionsupporting

confidence: 83%

Oral Anticoagulant Use by Emergency Medical Services Patients in the United States

Wang,

Yu,

Chu

et al. 2023

Preprint

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OBJECTIVEOral anticoagulant (OAC) use raises the risk of death in life-threatening conditions such as hemorrhagic stroke, trauma and traumatic brain injury. We sought to describe the national characteristics of Emergency Medical Services patients with a history of OAC use.METHODSWe used prehospital electronic medical record data from 2018-2020 from the ESO Data Collaborative. We included adults (age≥18 years) receiving 911 EMS care. OAC use included warfarin, dabigatran, rivaroxaban and apixaban. We determined the incidence of EMS calls by OAC users as well as their variation by EMS agency. We compared EMS call, patient, and response characteristics between OAC and non-OAC users, including primary impressions and hospital diagnoses.RESULTSThere were 16,244,550 adult 911 EMS events, including 906,575 by OAC users (56 per 1,000 911 events). Compared with non-OAC users, OAC users were more likely to be older (73.6 vs. 56.9 years), white (78.0% vs. 51.4%) and non-Hispanic (84.5% vs. 78.0%). Incidents involving OAC users were more likely at nursing homes, rehabilitation or long-term care facilities (17.0% vs. 9.2%) but less likely to involve trauma (14.7% vs. 18.1%) or cardiac arrest (1.2% vs. 1.4%). Among OAC users, the most common EMS primary clinical impressions were chest pain (7.4%), altered mental status (7.3%), injury (6.5%), abdominal pain (4.3%), and brain injury (2.8%).CONCLUSIONSIn this national series of prehospital events, 1 in 18 adult EMS encounters involved OAC users. These results provide key perspectives on the presentation of the OAC users in EMS care.

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Section: Discussionsupporting

confidence: 83%

Oral Anticoagulant Use by Emergency Medical Services Patients in the United States

Wang,

Yu,

Chu

et al. 2023

Preprint

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“…The discrepant findings may reflect differences in study populations, timing of measurement, and in defining OAC use 18 . However, treatment rates in both end‐of‐life populations were well below the overall population of residents with atrial fibrillation, consistent with concerns regarding adverse events and lower net benefit in these individuals 31–33 …”

Section: Discussionmentioning

confidence: 94%

“…18 However, treatment rates in both end-of-life populations were well below the overall population of residents with atrial fibrillation, consistent with concerns regarding adverse events and lower net benefit in these individuals. [31][32][33]…”

Section: Comparisons Of the Prevalence Of Oac Use And Discontinuation...mentioning

confidence: 99%

Discontinuation of oral anticoagulant use among nursing home residents with atrial fibrillation before hospice enrollment

Chen

Baek

Goldberg

et al. 2023

J American Geriatrics Society

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BackgroundOral anticoagulants (OACs) are effective in reducing the risk of cardioembolic stroke due to atrial fibrillation. While most nursing home residents with atrial fibrillation qualify for anticoagulation based on clinical guidelines, the net clinical benefits of OACs may diminish as residents approach the end of life.MethodsWe conducted a cross‐sectional study of 30,503 US nursing home residents with atrial fibrillation (based on Minimum Data Set 3.0 and Medicare Part A records) who used OACs in the year before enrolling in hospice care during 2012–2016. Whether residents discontinued OACs before hospice enrollment was determined using Part D claims and date of hospice enrollment. Modified Poisson models estimated adjusted prevalence ratios (aPR).ResultsAlmost half (45.7%) of residents who had recent OAC use discontinued prior to hospice enrollment. Residents who were underweight (aPR: 1.02; 95% confidence interval [CI]: 1.01–1.03), those with high bleeding risk (aPR: 1.04, 95% CI: 1.03–1.05), and those with moderate or severe cognitive impairment (aPR: 1.02, 95% CI: 1.02–1.03) had a higher prevalence of OAC discontinuation before entering hospice. Residents with venous thromboembolism (aPR: 0.94, 95% CI: 0.93–0.96), statin users (aPR: 0.88, 95% CI: 0.87–0.89), and those on polypharmacy (≥10 medications, aPR: 0.72; 95% CI: 0.71–0.73) were less likely to discontinue OACs before enrollment in hospice.ConclusionAnticoagulants are often discontinued among older nursing home residents with atrial fibrillation before hospice enrollment; it is not clear that these decisions are driven solely by net clinical benefit considerations. Further research is needed on comparative outcomes to inform resident‐centered decisions regarding OAC use in older adults entering hospice.

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“…De-prescribing or de-intensification of treatment was the explicit focus of a modest number of studies. [44][45][46][47][48][49][50][51][52][53] Research also examined specific categories of medications with known potential adverse effects for older adults, such as those with a high anticholinergic burden, [54][55][56][57][58][59][60][61] anticoagulants, [62][63][64][65][66][67][68] antidepressants, [69][70][71][72][73][74][75][76][77][78][79][80] anti-psychotics, 31 36 44 70 77 78 81-107 or statins. 49-51 108-112 Analysis of prescribing in some medication categories -antibiotics [113][114][115][116] or benzodiazepines, 84 117 for example, may be used to make broader assumptions about quality of care.…”

Section: Health Conditionsmentioning

confidence: 99%

Application and content of minimum data sets for care homes: A mapping review

Hanratty,

Akdur,

Burton

et al. 2024

Preprint

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BackgroundCare home residents have complex needs, and minimum data sets (MDSs) provide a unique source of information on their health and wellbeing. Although MDSs were first developed to monitor quality and costs of care, they can make an important contribution to research.AimTo describe the research applications of data from care home MDSs, and identify key outcome variables and measures used.DesignMapping review of published empirical studies using data generated from minimum data sets in long term care facilities for older adults.MethodsWe performed a comprehensive search of electronic databases (Medline OVID, CINAHL, Embase and ASSIA), using bespoke search strategies to identify English language publications 2011 - 2024. Articles were screened by two independent reviewers. They were grouped by study topic and data (on publication date, country, MDS, outcome variables and specific items or measures) were charted without quality assessment. The key features of the data are described in a narrative synthesis.FindingsSearches identified 18588 articles published 2011-2024, of which 661 met inclusion criteria. 72% were from the USA, 12% from Canada and the remaining 16% from four European countries, South Korea and New Zealand. The studies encompassed individual resident functioning (e.g. mobility, incontinence), health conditions and symptoms (e.g. depression, pain), healthcare in the home (e.g. prescribing, end of life care), hospital attendances and admissions, transitions to and from care homes, quality of care and systemwide issues. Measures used reflected the content of the major MDSs, but there was a mismatch between the importance of some topics to care homes (e.g. incontinence) and the range of published papers, and limited consensus over how to measure quality of life.ConclusionsCare home MDSs are a unique resource to support study of care home residents and impact of interventions over time. They are a powerful resource when linked to other datasets, and as an adjunct to primary data collection This analysis may serve as an accessible guide to the content and applications of MDS, allowing researchers to consider the sort of questions that can be posed and the different components of resident care or experience that can be evaluated.

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Geographic Variation in Anticoagulant Use and Resident, Nursing Home, and County Characteristics Associated With Treatment Among US Nursing Home Residents

Cited by 4 publications

References 46 publications

Oral Anticoagulant Use by Emergency Medical Services Patients in the United States

Oral Anticoagulant Use by Emergency Medical Services Patients in the United States

Discontinuation of oral anticoagulant use among nursing home residents with atrial fibrillation before hospice enrollment

Application and content of minimum data sets for care homes: A mapping review

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