Incidence and Predictors of Aspirin Discontinuation in Older Adult Veteran Nursing Home Residents at End-of-Life
| Autor: | Florentina E. Sileanu, Maria K. Mor, Mary Ersek, Xinhua Zhao, Loren J. Schleiden, Carolyn T. Thorpe, Joseph T. Hanlon, Sydney Springer, Joshua M. Thorpe, Joshua D. Niznik, Jacob N. Hunnicutt, Sherrie L. Aspinall, Walid F. Gellad |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Population 030204 cardiovascular system & hematology Article 03 medical and health sciences 0302 clinical medicine Deprescriptions Internal medicine Epidemiology medicine Secondary Prevention Humans Cumulative incidence 030212 general & internal medicine education Veterans Affairs Aged Retrospective Studies Skilled Nursing Facilities Veterans Aged 80 and over Minimum Data Set Aspirin education.field_of_study Terminal Care business.industry Retrospective cohort study United States Discontinuation United States Department of Veterans Affairs Heart Disease Risk Factors Chronic Disease Dementia Female Geriatrics and Gerontology business medicine.drug |
| Zdroj: | J Am Geriatr Soc |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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