Incidence and Predictors of Aspirin Discontinuation in Older Adult Veteran Nursing Home Residents at End of Life
Published 2020. This article is a U.S. Government work and is in the public domain in the USA..
OBJECTIVES: Continuation of aspirin for secondary prevention in persons with limited life expectancy (LLE) is controversial. We sought to determine the incidence and predictors of aspirin discontinuation in veterans with LLE and/or advanced dementia (LLE/AD) who were taking aspirin for secondary prevention at nursing home admission, stratified by whether their limited prognosis (LP) was explicitly documented at admission.
DESIGN: Retrospective cohort study using linked Veterans Affairs (VA) and Medicare clinical/administrative data and Minimum Data Set resident assessments.
SETTING: All VA nursing homes (referred to as community living centers [CLCs]) in the United States.
PARTICIPANTS: Older (≥65 y) CLC residents with LLE/AD, admitted for 7 days or longer in fiscal years 2009 to 2015, who had a history of coronary artery disease and/or stroke/transient ischemic attack, and used aspirin within the first week of CLC admission (n = 13 844).
MEASUREMENTS: The primary dependent variable was aspirin discontinuation within the first 90 days after CLC admission, defined as 14 consecutive days of no aspirin receipt. Independent variables included an indicator for explicit documentation of LP, sociodemographics, environment of care characteristics, cardiovascular risk factors, bleeding risk factors, individual markers of poor prognosis (eg, cancer, weight loss), and facility characteristics. Fine and Gray subdistribution hazard models with death as a competing risk were used to assess predictors of discontinuation.
RESULTS: Cumulative incidence of aspirin discontinuation was 27% (95% confidence interval [CI] = 26%-28%) in the full sample, 34% (95% CI = 33%-36%) in residents with explicit documentation of LP, and 24% (95% CI = 23%-25%) in residents with no such documentation. The associations of independent variables with aspirin discontinuation differed in residents with vs without explicit LP documentation at admission.
CONCLUSION: Just over one-quarter of patients discontinued aspirin, possibly reflecting the unclear role of aspirin in end of life among prescribers. Future research should compare outcomes of aspirin deprescribing in this population. J Am Geriatr Soc 68:725-735, 2020.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:68 |
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| Enthalten in: |
Journal of the American Geriatrics Society - 68(2020), 4 vom: 18. Apr., Seite 725-735 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Springer, Sydney P [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 29.01.2021 Date Revised 02.04.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/jgs.16346 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM306471167 |
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| 041 | |a eng | ||
| 100 | 1 | |a Springer, Sydney P |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Incidence and Predictors of Aspirin Discontinuation in Older Adult Veteran Nursing Home Residents at End of Life |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 29.01.2021 | ||
| 500 | |a Date Revised 02.04.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Published 2020. This article is a U.S. Government work and is in the public domain in the USA. | ||
| 520 | |a OBJECTIVES: Continuation of aspirin for secondary prevention in persons with limited life expectancy (LLE) is controversial. We sought to determine the incidence and predictors of aspirin discontinuation in veterans with LLE and/or advanced dementia (LLE/AD) who were taking aspirin for secondary prevention at nursing home admission, stratified by whether their limited prognosis (LP) was explicitly documented at admission | ||
| 520 | |a DESIGN: Retrospective cohort study using linked Veterans Affairs (VA) and Medicare clinical/administrative data and Minimum Data Set resident assessments | ||
| 520 | |a SETTING: All VA nursing homes (referred to as community living centers [CLCs]) in the United States | ||
| 520 | |a PARTICIPANTS: Older (≥65 y) CLC residents with LLE/AD, admitted for 7 days or longer in fiscal years 2009 to 2015, who had a history of coronary artery disease and/or stroke/transient ischemic attack, and used aspirin within the first week of CLC admission (n = 13 844) | ||
| 520 | |a MEASUREMENTS: The primary dependent variable was aspirin discontinuation within the first 90 days after CLC admission, defined as 14 consecutive days of no aspirin receipt. Independent variables included an indicator for explicit documentation of LP, sociodemographics, environment of care characteristics, cardiovascular risk factors, bleeding risk factors, individual markers of poor prognosis (eg, cancer, weight loss), and facility characteristics. Fine and Gray subdistribution hazard models with death as a competing risk were used to assess predictors of discontinuation | ||
| 520 | |a RESULTS: Cumulative incidence of aspirin discontinuation was 27% (95% confidence interval [CI] = 26%-28%) in the full sample, 34% (95% CI = 33%-36%) in residents with explicit documentation of LP, and 24% (95% CI = 23%-25%) in residents with no such documentation. The associations of independent variables with aspirin discontinuation differed in residents with vs without explicit LP documentation at admission | ||
| 520 | |a CONCLUSION: Just over one-quarter of patients discontinued aspirin, possibly reflecting the unclear role of aspirin in end of life among prescribers. Future research should compare outcomes of aspirin deprescribing in this population. J Am Geriatr Soc 68:725-735, 2020 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, U.S. Gov't, Non-P.H.S. | |
| 650 | 4 | |a chronic disease management | |
| 650 | 4 | |a deprescribing | |
| 650 | 4 | |a end of life | |
| 650 | 4 | |a epidemiology | |
| 650 | 4 | |a veterans | |
| 650 | 7 | |a Aspirin |2 NLM | |
| 650 | 7 | |a R16CO5Y76E |2 NLM | |
| 700 | 1 | |a Mor, Maria K |e verfasserin |4 aut | |
| 700 | 1 | |a Sileanu, Florentina |e verfasserin |4 aut | |
| 700 | 1 | |a Zhao, Xinhua |e verfasserin |4 aut | |
| 700 | 1 | |a Aspinall, Sherrie L |e verfasserin |4 aut | |
| 700 | 1 | |a Ersek, Mary |e verfasserin |4 aut | |
| 700 | 1 | |a Niznik, Joshua D |e verfasserin |4 aut | |
| 700 | 1 | |a Hanlon, Joseph T |e verfasserin |4 aut | |
| 700 | 1 | |a Hunnicutt, Jacob |e verfasserin |4 aut | |
| 700 | 1 | |a Gellad, Walid F |e verfasserin |4 aut | |
| 700 | 1 | |a Schleiden, Loren J |e verfasserin |4 aut | |
| 700 | 1 | |a Thorpe, Joshua M |e verfasserin |4 aut | |
| 700 | 1 | |a Thorpe, Carolyn T |e verfasserin |4 aut | |
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