2011 National Meeting

3042 — Is ACEI/ARB Prescription Associated with Mortality and Heart Failure (HF) Hospitalization among VA Nursing Home Residents with HF

Hutt E (Eastern VA Colorado Health Care System) , Ho PM (Eastern VA Colorado Health Care System), Pointer L (Eastern VA Colorado Health Care System)

Objectives:
Determine whether associations exist between angiotensin converting enzyme inhibitor or receptor blocker (ACEI/ARB) prescription, mortality and HF rehospitalization in a national sample of VA nursing home (community living center – CLC) residents with HF.

Methods:
A national cohort of 13,147 veterans with diagnosed HF residing in CLCs during 2003-4 was identified from the VA’s Medical SAS and Minimum Data Set files. The outcomes of death or subsequent hospitalization for HF, and covariates including demographics, baseline function, biochemical markers, comorbidity, facility characteristics, and other medications were compared on ACEI/ARB exposure. Propensity to be prescribed an ACEI/ARB was derived using nonparsimonious logistic regression. The association between ACEI/ARB and adverse outcomes was assessed by Cox proportional hazards regression using the propensity-matched cohort (n = 7,368) adjusting for baseline demographics, co-morbidities, function and biochemical markers.

Results:
Annual mortality was 27.6% and HF rehospitalization 16%. Fifty percent of subjects had any advance directive. Fifty-eight percent had been prescribed ACEI/ARB; approximately 60% had been prescribed a beta-blocker and/or a loop diuretic. After multivariable adjustment, subjects prescribed ACEI/ARB had a lower mortality risk (Hazard Ratio 0.81, 95% CI: 0.74 - 0.89). Hazard ratios for HF hospitalization were not associated with ACEI/ARB prescription except in the subset of subjects who were prescribed neither a beta-blocker nor a loop diuretic (n = 8,947) (HR 0.66, 95% CI: 0.48-0.91).

Implications:
ACEI/ARB prescription was associated with better survival of VA CLC subjects with HF. In the subset of subjects taking neither a beta blocker nor a loop diuretic, ACEI/ARB prescription was also associated with reduced risk of HF hospitalization.

Impacts:
Like in community nursing homes, ACEI/ARB prescription is associated with reduced mortality in CLC residents with HF. CLCs are an important source of HF rehospitalization, because 1/3 of CLC residents have diagnosed HF. Since this study finds, for the first time, an association between ACEI/ARB prescription and reduced HF rehospitalization among some CLC residents, future studies developing an intervention to improve care processes in CLCs may lead to an overall reduction in HF rehospitalization, a key VA quality measure.