Relationships among resident, physician, and facility characteristics, angiotensin-converting enzyme inhibitor use, and hospital utilization in elderly nursing home residents with heart failure
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This study aimed to determine the relationships among resident, physician, and facility characteristics and ACE inhibitor use; and those between ACE inhibitor use and hospital utilization in elderly nursing home residents with heart failure. The study sample (N=468) consisted of predominately white female residents with an average age of 86.0 years (SD=8.0, range=65 to 106). Of the overall sample, 30.8% (n=144) of the residents received ACE inhibitor therapy, 64.1% (n=300) received a loop diuretic, 28.8% (n=135) received digoxin, 22.9% (n=107) received a beta-blocker, 7.5% (n=35) received a potassium-sparing diuretic, and 5.3% (n=25) received an angiotensin II receptor blocker. Residents’ number of selected concomitant conditions was the only characteristic significantly associated with “any ACE inhibitor use” (OR = 1.462, 95% CI = 1.184 – 1.804, p<0.001), controlling for all other characteristics. With regards to hospital vi utilization, ACE inhibitor users had lower likelihood of hospitalization due to any cause than non-users. A smaller proportion of ACE inhibitor users than non-users were hospitalized for any reason (16.7%, n=9 versus 59.1%, n=68) and for heart failure at least once during the observation period (5.5%, n=3 versus 29.6%, n=34). ACE inhibitor use (OR = 0.150, 95% CI = 0.046 – 0.484, p=0.001) and length of the observation period (OR = 1.679, 95% CI = 1.316 – 2.143, p<0.001) were significantly associated with the likelihood of being hospitalized for any reason, controlling for all characteristics and ACE inhibitor use. Sensitivity analyses of the models for hospitalization due to any cause and due to heart failure showed similar results. The findings for hospital utilization suggest that ACE inhibitor therapy may contribute to reduced likelihood of hospitalization. Future research should explore further the relationships among resident characteristics, physician prescribing behaviors, organizational resources, other heart failure drug therapies such as beta-blockers, and resident outcomes.