Use of Diabetes Medications before and after a Heart Failure-Related Hospitalization among Nursing Home Residents
Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved..
OBJECTIVES: Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) offer cardiovascular benefits, whereas thiazolidinediones (TZDs) and sulfonylureas (SUs) increase cardiovascular risk. The objective of this study was to describe the use of SGLT-2is, GLP-1RAs, TZDs, and SUs before and after a heart failure (HF)-related hospitalization in nursing home (NH) residents with type 2 diabetes (T2D).
DESIGN: This was a cohort study using a 20% sample of Medicare claims linked with Minimum Data Set resident assessments.
SETTING AND PARTICIPANTS: The study population was long-stay NH residents with T2D and an HF-related hospitalization between January 1, 2013, and August 31, 2018. For individuals with multiple HF hospitalizations, 1 hospitalization was randomly selected.
METHODS: We ascertained diabetes medications using Medicare Part D claims during the 120 days before and after hospital discharge (or skilled nursing facility discharge, where applicable). We calculated (1) the proportion of study participants who received a medication class of interest during pre- and posthospitalization periods; (2) the proportion of continuous users; and (3) the proportion of posthospitalization users who were new users.
RESULTS: A total of 12,990 NH residents with T2D and an HF-related hospitalization were included (mean age 78 years, 66% female, 19% Black). Before hospitalization, 1.5% received TZDs, 14.1% received SUs, 1.2% received GLP-1RAs, and 0.3% received SGLT-2is. Among prehospitalization users of TZDs, SUs, GLP-1RAs, and SGLT-2is, 49%, 62%, 60%, and 40% continued the medications, respectively. Among posthospitalization users of TZDs, SUs, GLP-1RAs, and SGLT-2is, 37%, 10%, 28%, and 11%, respectively, were new users.
CONCLUSIONS: Among NH residents with hospitalized HF, GLP-1RAs and SGLT-2is were seldom used. TZDs and SUs were still used by many residents with T2D after HF hospitalizations.
IMPLEMENTATIONS: Barriers may exist in the use of newer diabetes medications to prevent heart failure in NH residents with T2D, which warrants further studies in older adults with multimorbidity.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:25 |
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| Enthalten in: |
Journal of the American Medical Directors Association - 25(2024), 3 vom: 15. März, Seite 454-458 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zhang, Tingting [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 04.03.2024 Date Revised 16.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jamda.2023.06.033 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM360527140 |
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| 245 | 1 | 0 | |a Use of Diabetes Medications before and after a Heart Failure-Related Hospitalization among Nursing Home Residents |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 04.03.2024 | ||
| 500 | |a Date Revised 16.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) offer cardiovascular benefits, whereas thiazolidinediones (TZDs) and sulfonylureas (SUs) increase cardiovascular risk. The objective of this study was to describe the use of SGLT-2is, GLP-1RAs, TZDs, and SUs before and after a heart failure (HF)-related hospitalization in nursing home (NH) residents with type 2 diabetes (T2D) | ||
| 520 | |a DESIGN: This was a cohort study using a 20% sample of Medicare claims linked with Minimum Data Set resident assessments | ||
| 520 | |a SETTING AND PARTICIPANTS: The study population was long-stay NH residents with T2D and an HF-related hospitalization between January 1, 2013, and August 31, 2018. For individuals with multiple HF hospitalizations, 1 hospitalization was randomly selected | ||
| 520 | |a METHODS: We ascertained diabetes medications using Medicare Part D claims during the 120 days before and after hospital discharge (or skilled nursing facility discharge, where applicable). We calculated (1) the proportion of study participants who received a medication class of interest during pre- and posthospitalization periods; (2) the proportion of continuous users; and (3) the proportion of posthospitalization users who were new users | ||
| 520 | |a RESULTS: A total of 12,990 NH residents with T2D and an HF-related hospitalization were included (mean age 78 years, 66% female, 19% Black). Before hospitalization, 1.5% received TZDs, 14.1% received SUs, 1.2% received GLP-1RAs, and 0.3% received SGLT-2is. Among prehospitalization users of TZDs, SUs, GLP-1RAs, and SGLT-2is, 49%, 62%, 60%, and 40% continued the medications, respectively. Among posthospitalization users of TZDs, SUs, GLP-1RAs, and SGLT-2is, 37%, 10%, 28%, and 11%, respectively, were new users | ||
| 520 | |a CONCLUSIONS: Among NH residents with hospitalized HF, GLP-1RAs and SGLT-2is were seldom used. TZDs and SUs were still used by many residents with T2D after HF hospitalizations | ||
| 520 | |a IMPLEMENTATIONS: Barriers may exist in the use of newer diabetes medications to prevent heart failure in NH residents with T2D, which warrants further studies in older adults with multimorbidity | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a glucagon-like peptide-1 receptor agonists | |
| 650 | 4 | |a sodium-glucose cotransporter-2 inhibitors | |
| 650 | 4 | |a sulfonylureas | |
| 650 | 4 | |a thiazolidinediones | |
| 650 | 7 | |a Sodium-Glucose Transporter 2 Inhibitors |2 NLM | |
| 650 | 7 | |a Sulfonylurea Compounds |2 NLM | |
| 700 | 1 | |a Zullo, Andrew R |e verfasserin |4 aut | |
| 700 | 1 | |a Hayes, Kaleen Kaley N |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Dae Hyun |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Yoojin |e verfasserin |4 aut | |
| 700 | 1 | |a Daiello, Lori A |e verfasserin |4 aut | |
| 700 | 1 | |a Kiel, Douglas P |e verfasserin |4 aut | |
| 700 | 1 | |a Berry, Sarah D |e verfasserin |4 aut | |
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